摘要
目的 探讨一期后路椎管与椎间孔扩大减压术治疗颈椎后纵韧带骨化症(OPLL)伴根性症状的疗效。方法 2016年1月至2020年1月重庆医科大学附属第一医院骨科采用一期后路椎管与椎间孔扩大减压术治疗OPLL患者26例。患者年龄为(62.71±12.01)岁;病程为(11.43±13.67)个月。颈椎OPLL的分布类型为局限型2例、连续型11例、混合型13例。根性症状节段C5为15例,C6为11例。后路椎板切除减压14例,椎板成形12例。采用视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、日本骨科协会评分(JOA)和并发症评估临床疗效。所有患者术前术后均完善颈椎CT检查并进行三维重建,观察颈椎根性症状责任节段椎间孔形态,并测量最佳角度下的纵径、上前后径、下前后径以及手术前后的根性症状责任节段曲度及颈椎曲度做影像学评估。结果 随访(24.29±10.81)个月。手术时间(136.28±26.38)min;术中失血量(164.29±140.58)ml;住院费用(800058±22847)元;住院时间(13.43±3.45)d。手术3节段11例,4节段9例,5节段6例。末次随访时VAS、NDI和JOA评分较术前明显改善(P<0.05)。其中1例患者术后出现左侧C5神经根麻痹,进行前路翻修手术;末次随访时疗效较好。根性责任节段椎间孔纵径、根性责任节段曲度、颈椎曲度手术前后差异无统计学意义(P>0.05);而根性责任椎间孔上前后径和下前后径术后获得较好的改善(P<0.05)。结论 一期后路椎管与椎间孔扩大减压治疗伴根性症状的OPLL可获得较好临床与影像学效果。
Objective To investigated the technique of the posterior decompression and foraminotomy for ossification of posterior longitudinal ligament(OPLL)with radiculopathy.Methods From January 2016 to January 2020,26 patients with OPLL with radiculopathy underwent posterior decompression and foraminotomy in Department of Orthopedic surgery,the First Affiliated Hospital of Chongqing Medical University.The age,course of disease,surgery time,intraoperative blood loss,hospitalization cost and hospital stay were(62.71±12.01)years,(11.43±13.67)months,(136.28±26.38)minutes and(164.29±140.58)ml,(800058±22847)yuan,(13.43±3.45)days respectively.The distribution types of cervical OPLL were localized in 2 cases,continuous in 11 cases and mixed in 13 cases.There were 15 cases in C5 radiculopathy and 11 cases in C6 radiculopathy.Posterior laminectomy and decompression were performed in 14 cases and laminoplasty in 12 cases.The posterior decompression was conducted by laminectomy or laminoplasty while the foraminotomy was performed to relieve the nerve root after posterior decompression.Clinical data were collected including Visual Analogue Scale(VAS)score,neck disability index(NDI),Japanese Orthopedic Association(JOA)score,and complications.The imaging evaluation were performed in all patients by CT three-dimensional reconstruction before and after operation,observing the morphology of intervertebral foramen at the responsible segment of cervical root symptoms,and measuring the longitudinal diameter,upper anterioroposterior diameter and lower anterioroposterior diameter at the best angle.The cobb angle was measured at responsible segment curvature and cervical curvature.The SAS software was used to analyze the data.Results The follow-up time was(24.29±10.81)months.There were 11 cases in 3 segments of surgical levels,9 cases in 4 segments and 6 cases in 5 segments.At the final follow-up,the VAS,NDI and JOA scores were significantly improved compared with those before operation(P<0.05).One patient developed left C5 paralysis after operation and underwent revision anterior surgery and achieved good recovery at the final follow-up.There was no significant difference in the longitudinal diameter of the intervertebral foramen of the root responsible segment,the curvature of the responsible segment and the curvature of the cervical spine before and after operation(P>0.05).The upper anterioroposterior diameter and the lower anterioroposterior diameter of the responsible intervertebral foramen were better improved after operation(P<0.05).Conclusion Posterior decompression and foraminotomy for OPLL with radiculopathy could achieved good clinical and radiographic results.
作者
钟伟洋
秦杰
唐可
权正学
Zhong Weiyang;Qin Jie;Tang Ke;Quan Zhengxue(Department of Orthopedic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)
出处
《骨科临床与研究杂志》
2022年第3期139-143,共5页
Journal Of Clinical Orthopedics And Research
基金
国家自然科学基金(82072976)
重庆市科卫联合项目(2021MSXM285)。
关键词
颈椎
后纵韧带骨化
神经根
影像学评估
Cervical vertebrae
Ossification of the posterior longitudinal ligament
Nerve root
