【摘要】 目的探讨颈椎黄韧带切除术在颈椎管狭窄症治疗中的临床应用。方法1997年6月-2007年6月,收治黄韧带病变为主的退变性颈椎管狭窄症25例,其中男22例,女3例;年龄32～68岁,平均54岁。病程3周～7年,平均3年7个月。5例术前2～3周有颈椎外伤史(3例摔伤,2例车祸伤)。黄韧带压迫部位:C4～712例,C3～79例,C5～73例,C6、71例。25例均行后路黄韧带切除术;12例于术后1周～3个月行前路颈椎间盘切除或椎体开槽并椎间植骨融合术。结果黄韧带切除术手术时间60～180min,平均95min;术中出血90～360mL,平均210mL。2例术中颈椎过度屈曲致刀尖划破硬膜2～3mm,即刻缝合修补,术后未出现脑脊液漏。术后切口均Ⅰ期愈合。25例均获随访,随访时间2～10年,平均3年9个月。患者均无轴性症状等并发症发生,颈椎管狭窄部位无再狭窄。术前有效椎管与脊髓截面积的比值为1.12±0.07,术后24个月为2.11±0.19,差异有统计学意义(P<0.05)。13例未行前路手术者术前颈椎活动度为(39.4±3.2)°,术后24个月为(42.1±2.9)°,差异无统计学意义(P>0.05);12例行前路手术患者术前颈椎活动度为(34.3±3.4)°,术后24个月为(29.2±3.6)°,差异有统计学意义(P<0.05)。行前路椎间植骨融合术患者植骨块于术后3～5个月愈合,平均3.8个月。术前日本骨科协会(JOA)评分为(7.9±2.2)分,术后24个月为(15.6±1.4)分,差异有统计学意义(P<0.05),平均改善率为86.3%。结论颈椎黄韧带切除术能解除黄韧带肥厚病变对脊髓神经的压迫,不破坏正常椎管的完整性,能避免颈椎管开门扩大成形术后并发症的发生。更多还原

【Abstract】 Objective To investigate the operational method of cervical vertebral flavectomy and its clinical application in the management of cervical canal stenosis.Methods From June 1997 to June 2007,25 patients suffering from cervical spinal canal stenosis caused by obvious flaval ligament hypertrophy were given flavectomy.There were 22 males and 3 females,with an age range of 32 to 68 years(average 54 years).The course of disease was from 3 weeks to 7 years,with an average of 3 years and 7 months.All patients had degenerative cervical canal stenosis;of them,5 cases had a history of cervical injury 2 to 3 weeks before operation(3 cases of falling injury and 2 cases of traffic accident injury).The X-ray film,CT,and MRI examinations showed that the compression locations were C4-7 in 12 cases,C3-7 in 9 cases,C5-7 in 3 cases,and C6,7 in 1 case.Spinous process and vertebral lamella were exposed by central posterior approach.The insertions of flaval ligaments were cut off at the superior vertebral lamella border,then the starting points of which were cut down from the anterior side of the upper vertebral lamella at their inferior border after lifting up the flaval ligaments.The residual flaval ligaments in front of the vertebral lamella were scraped off by slope rongeur,the dura mater then could be seen to inflate from the intervertebral lamella space,showing the compression having been relieved.Twenty-five cases were all given posterior flavectomy.At 1 week to 3 months after operation,12 patients received anterior cervical discectomy or vertebral gaining decompression with fusion by bone graft.Results The time for flavectomy was from 60 to 180 minutes,with an average of 95 minutes.The blood loss during operation was from 90 to 360 mL,with an average of 210 mL.The dura maters were lacerated by knife tips during operation with the cervical vertebrae in hyperflexion in 2 cases.Immediate suture and repair were performed and there were no postoperative cerebrospinal fluid leakage.All the incisions healed by first intension after operation.All of the 25 cases were followed up from 2 to 10 years,with an average of 3 years and 9 months.All patients had no complication of axial symptoms,and no restenosis at their operation site of cervical canal stenosis.The section area ratios of functional spinal canal to spinal cord were 1.12±0.07 before operation and 2.11±0.19 at 24 months after operation,showing significant difference(P<0.05).The range of motion of cervical vertebrae was(39.4±3.2)obefeore operation and(42.1±2.9)°at 24 months after operation in 13 cases without anterior cervical discectomy fusion,showing no significant difference(P>0.05);was(34.3±3.4)°before operation and(29.2±3.6)°at 24 months after operation in 12 cases with anterior cervical discectomy fusion,showing significant difference(P<0.05).The bone graft achieved bony union 3-5 months after operation(average 3.8 months).The Japanese Orthopaedic Association(JOA) scores were 7.9±2.2 before operation and 15.6±1.4 at 24 months after operation,showing significant difference(P<0.05),with an average improvement rate of 86.3%.Conclusion Cervical flavectomy could relieve compression to spinal cord and nerves caused by the flaval ligament hypertrophy without damaging the normal integrality of bony canal,thus avoiding the complication of axial symptoms and so on which are encountered in open-door expansile cervical laminoplasty.更多还原