摘要
目的探讨后纵韧带钩辅助下颈椎后纵韧带骨化物前路切除的适应证、方法及其临床效果。方法患者19例，男14例，女5例；年龄51-71岁，平均59岁。术前影像学检查结果示后纵韧带骨化物局限型6例，分节型13例；椎管狭窄率32％-75％，平均54％。术前神经功能JOA评分4-14分，平均9．6分。行颈前路常规手术入路，椎体开槽切骨达椎体后壁，范围超过后纵韧带骨化灶。利用后纵韧带钩插入后纵韧带下，钩起后纵韧带及骨化物，在后纵韧带与硬膜间形成一间隙，直视下用超薄型枪状咬骨钳切除后纵韧带及骨化物，而后植骨固定，恢复颈椎稳定性。结果随访6-36个月，平均16个月。术后JOA评分8～16分，平均12．8分，恢复率42％＇-92％，其中疗效优9例，良7例，可3例，优良率84．2％。4例患者术后并发脑脊液漏，保守治疗后均获得痊愈。术后CT和MR检查显示骨化后纵韧带切除完全，脊髓和硬膜囊形态恢复良好。结论后纵韧带钩可提高颈椎前路手术切除后纵韧带骨化物的安全性和有效性，适用于局限型和分节型、切除范围在两个椎节之间的颈椎后纵韧带骨化症患者。
Objective To study the indications, methods and clinical effect of ossification of posterior longitudinal ligament（OPLL） removed with the assistance of a posterior longitudinal ligament hook for anterior decompression. Methods Nineteen patients （14 males and 5 females, age range from 51 to 71 years） with OPLL underwent anterior decompression. Preoperative radiological studies revealed that the ossification was localized type in 6 patients and segmental type in 13. The narrowing ratio was 32%-75% with an average of 54%. The preoperative neurological JOA scores were 4-14 points with an average of 9.6 points. The cervical spine was exposed through a standard anterior approach; and the vertebral bodies were partially removed using an appropriate reamer until the OPLL was fully exposed. The OPLL was then separated from the underlying dura mater with the assistance of the posterior longitudinal ligament hook designed by ourselves. After that, the ligament was slightly lifted and removed by Kerrison uhrathin-rongeurs. Finally, bone grafting and anterior cervical screw plate fixation were performed across the segaments to restore the stability of the cervical spine. Results The patients were followed up from 6 to 36 months （average, 16 months）. The postoperative JOA scores were 8-16 points with an average of 12.8 points, and the recovery rate of neurological function was from 42% to 92%. Of them, the clinical result was excellent in 9 patients, good in 7, fair in 3, resulting in 84.2% of excellent and good rate. The transient leak of SCF occurred in 4 cases and all cured by conservative treatment. Postoperative CT scans and MRI showed that the ossification was thoroughly removed and appearance of the spinal cord recovered. Conclusion The ossified ligaments could be removed directly in the patients with OPLL, including localized and segmental types, which was no more than 2 levels. The posterior longitudinal ligament hook, with a significant assistant effect, made this procedure safer and more reliable.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第6期434-437,共4页
Chinese Journal of Orthopaedics
关键词
颈椎
骨化
后纵韧带
减压术
外科
Cervical vertebrae
Ossification of posterior longitudinal ligament
Decompression, surgical
