摘要
背景:颈椎后纵韧带骨化症(OPLL)在亚洲高发,连续型或混合型OPLL常采用颈椎后路椎板成形术治疗。此类病例中有骨化灶侵及C2或C2以上水平造成脊髓压迫的情况,需进行手术减压。但同时可能破坏颈半棘肌和头半棘肌的肌肉附着点,造成颈椎前凸丢失和术后轴性疼痛。目的:观察保留或重建棘突肌肉附着点的C2椎板穹窿状减压联合棘突纵割式椎板成形术(SLAC)治疗高位颈椎OPLL的临床及影像学疗效。方法:采用回顾性病例系列研究的方法,选取2017年1月至2018年12月在我院因颈椎后纵韧带骨化症且骨化灶压迫侵及C2/3椎间盘水平及以上的手术患者,对该组患者行C2椎板穹隆状减压联合SLAC术。对比术前及末次随访的颈椎JOA评分、颈椎功能障碍指数(NDI)、颈肩痛视觉模拟评分(VAS)、颈椎前凸角等指标,并记录并发症情况。部分患者行术后CT,测量脊髓容纳空间(SAC),并与术前对比,评价影像学效果。结果:共27例患者纳入本研究,其中男21例,女6例,年龄40~81岁,平均(63.9±8.3)岁。随访时间6~20个月,平均(12.9±4.0)个月。与术前比较,末次随访时颈椎JOA评分显著增加(10.8±1.2vs 12.9±1.7,P=0.001),NDI(26.3±6.2 vs 14.4±5.9,P<0.001)、颈椎前凸角(11.6°±6.9°vs 8.3°±6.2°,P=0.004)显著降低,差异均有统计学意义;但颈肩痛VAS评分(2.4±1.0 vs 2.9±1.3,P=0.131)差异无统计学意义。13例患者术后即刻行CT扫描,手术前后C2水平SAC差异有统计学意义[(6.1±1.9)mm vs(15.3±2.5)mm,P<0.001]。结论:保留或重建棘突肌肉附着点的C2椎板穹窿状减压联合棘突纵割式椎板成形术的临床及影像学结果满意,并不增加术后颈肩部轴性疼痛,可作为治疗高位颈椎后纵韧带骨化症的手术选择。
Background:Cervical ossification of posterior longitude ligament(OPLL)has a high incidence in Asia.The laminoplasty was routinely adapted for the continuous or mixed type of OPLL.Sometimes the OPLL lesions infiltrate to C2 level or above.The attachment of musculus semispinalis cervicis and musculus semispinalis capitis to C2 spinal process will be destroyed when decompression,inducing the decrease of cervical lordosis and postoperative axial pain.Objective:To observe the clinical and radiographic results of C2 dome-shaped sublaminar decompression(retaining or reconstruction muscle insertion of C2 spinous process)combined with spinous process splitting laminoplasty with coral bone in the treatment of high-level cervical OPLL.Methods:Patients with OPLL at or higher than C2/3 level,who were treated with C2 dome-shaped sublaminar decompression combined with spinous process splitting laminoplasty with coral bone procedure in our hospital from January2017 to December 2018 were enrolled in this retrospective case series study.Cervical JOA score,neck disability index(NDI),axial pain visual analogue scale(VAS)and cervical lordosis angle were recorded before operation and at the last follow-up,as well as postoperative complications.Space available for the spinal cord(SAC)from CT scanning was measured to evaluate the radiographic results.Results:A total of 27 patients were enrolled in this study.There were 21 males and 6 females with a mean age of(63.9±8.3)years(range,40-81 years).The mean follow-up time was(12.9±4.0)months(range,6-20 months).Compared with preoperative ones,cervical JOA score was significantly increased at the last follow-up(10.8±1.2 vs 12.9±1.7,P=0.001),while NDI(26.3±6.2 vs 14.4±5.9,P<0.001)and cervical lordosis angle(11.6°±6.9°vs 8.3°±6.2°,P=0.004)were significantly decreased.The axial pain VAS was not significantly changed at the last follow-up compared to preoperation(2.4±1.0 vs 2.9±1.3,P=0.131).Thirteen patients took CT scan immediately after surgery,and SAC at the C2 level was significantly increased([6.1±1.9]mm vs[15.3±2.5]mm,P<0.001).Conclusions:Clinical and radiographic results of C2 dome-shaped sublaminar decompression(retaining or reconstruction muscle insertion of C2 spinous process)combined with spinous process splitting laminoplasty with coral bone are satisfactory,and postoperative axial pain is not increased.It can be taken as a good option for high-level cervical OPLL.
作者
茅剑平
肖斌
行勇刚
刘波
何达
胡临
袁强
孙宇庆
范明星
田伟
MAO Jianping;XIAO Bin;XING Yonggang;LIU Bo;HE Da;HU Lin;YUAN Qiang;SUN Yuqing;FAN Mingxing;TIAN Wei(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华骨与关节外科杂志》
2020年第5期367-371,共5页
Chinese Journal of Bone and Joint Surgery
关键词
颈椎
后纵韧带骨化症
椎板成形术
手术治疗
Cervical Spine
Ossification of Posterior Longitude Ligament(OPLL)
Laminoplasty
Surgical Treatment
作者简介
通信作者:田伟,E-mail:tianwei_victor@163.com
