颈前路漂浮减压植骨融合内固定术治疗颈椎后纵韧带骨化症疗效观察

摘要

目的：观察颈前路漂浮减压植骨融合内固定术治疗孤立型颈椎后纵韧带骨化症的临床效果。方法36例孤立型颈椎后纵韧带骨化症患者，接受颈前路漂浮减压植骨融合内固定术治疗。术后观察患者颈椎曲度指数（ CCI）、神经功能恢复及相关并发症发生情况。结果所有患者均顺利完成手术，术后未出现神经症状加重及脊髓损伤等情况。手术时间81～155（116．0±21．3）min。术中出血190～410（227．0±35．5）mL。术后5例患者发生脑脊液漏，经局部加压包扎及腰大池置管引流后均好转。随访时间15～46个月，随访期间未出现内固定物松动、移位、脱出等情况。术后患者神经功能均获得明显改善，JOA评分术前为（8．5±2．1）分，术后3个月为（13．0±3．3）分，末次随访时为（13．7±3．6）分，后两者与术前比较，P均＜0．05。神经功能改善率为70．1％±13．8％。 CCI术前为14．2％±4．3％，术后3 d为13．8％±4．6％，末次随访时为12．9％±4．4％，三者比较，差异无统计学意义。结论颈前路漂浮减压植骨融合内固定术治疗孤立型颈椎后纵韧带骨化症能彻底解除脊髓前方的骨性压迫，恢复并重建颈椎生理曲度，效果满意。%Objective To observe the clinical effects of anterior floating decompression and internal fixation in treat-ment of isolated cervical ossification of posterior longitudinal ligament ( OPLL) .Methods A total of 36 cases of cervical OPLL patients in isolated type accepted the procedure of anterior floating decompression combined with titanium mesh im-plant and internal fixation.The cervical curvature index ( CCI) , postoperative neurological recovery and complications were recorded and analyzed.Results The operation was successful in all patients, and no aggravation of neurological symptoms and spinal cord injury were found after the surgery.The operative time was 81-155 ( mean 116.0 ±21.3) min with a blood loss of 190-410 (mean 227.0 ±35.5) mL.Five cases of cerebrospinal fluid leakage occurred after the surgery, and healed well after local compression and lumbar catheter drainage.During the follow-up of 15-46 months, no internal fixation loose-ness, dislocation and extrusion happened.The Japanese Orthopedic Association (JOA) scale was improved form (8.5 ± 2.1) preoperatively to (13.0 ±3.3) three months after surgery, and (13.7 ±3.6) at the final follow-up; significant difference was found between that before and after operation (all P<0.05).The neurological recovery rate was (70.1 ± 13.8)%.The CCI was 14.2% ±4.3%before operation, 13.8%±4.6%three days after surgery, and 12.9%±4.4%at the final follow-up, and no statistical difference was found between them.Conclusion Anterior floating decompression and internal fixation in treatment of isolated cervical OPLL could completely remove the bony compression directly and re-store the physiological curvature, and it has good effect.