【摘要】 目的：探讨术中调整颈椎曲度并行肌肉重建的双开门椎管成形术治疗伸展位K线阳性的颈椎后纵韧带骨化症（OPLL）的疗效。方法：回顾性分析2020年8月至2022年3月行颈椎双开门椎管成形术的标准位K线阴性且伸展位K线阳性的50例OPLL患者的临床资料。其中25例患者术中未调整颈椎曲度（常规重建组），25例患者术中调整颈椎曲度（曲度重建组）。比较两组患者手术时间、术中出血量，同时比较两组患者术前与术后3个月日本骨科协会（JOA）评分及JOA评分改善率、术前及术后3个月颈椎生理曲度（CLA），以及术后3个月出现抬头无力和轴性症状的比例。结果：两组患者手术时间及术中出血量差异均无统计学意义（P均>0.05）。术后3个月常规重建组患者JOA评分由术前的（10.9±0.7）分提高到（14.4±0.7）分，JOA评分改善率为（56.7±11.4）%;CLA由术前的10.3°±1.0°提高到11.2°±0.9°；术后3个月曲度重建组患者JOA评分由术前的（10.8±0.7）分提高到（15.0±0.5）分，JOA评分改善率为（68.3±7.1）%;CLA由术前的10.4°±0.8°提高到14.7°±1.2°。术后3个月两组患者JOA评分、JOA评分改善率、CLA及出现轴性症状的比例差异均有统计学意义（P均<0.05），而出现抬头无力的比例差异无统计学意义（P>0.05）。结论：术中调整颈椎曲度并行肌肉重建的双开门椎管成形术治疗标准位K线阴性且伸展位K线阳性的颈椎OPLL能够改善患者术后CLA，有效缓解临床症状。更多还原

【Abstract】 Objective: To investigate the clinical efficacy of double-door laminoplasty with intraoperative cervical curvature adjustment and parallel muscle reconstruction for the treatment of cervical ossification of posterior longitudinal ligament(OPLL) with K-line(+) in the extension position. Methods: A retrospective analysis was conducted on 50 OPLL patients with K-line(-) in the standard position and K-line(+) in the extension position who underwent cervical double-door laminoplasty from August 2020 to March 2022. The patients were divided into two groups based on whether the cervical curvature adjustments were performed intraoperatively: conventional reconstruction group(25 patients) and curvature reconstruction group(25 patients). Surgical duration,intraoperative blood loss, the preoperative and 3-month postoperative Japanese Orthopedic Association(JOA) score, the JOA improvement rate, and cervical physiological curvature(CLA), as well as the proportion of patients experiencing head lift weakness and axial symptoms at 3 months postoperatively were compared between the two groups. Results: There were no statistically significant differences in surgical duration and blood loss, between the two groups(P>0.05). Three months after surgery, in the conventional reconstruction group, the JOA score improved from(10.9±0.7) to(14.4±0.7), with an improvement rate of(56.7±11.4)%; CLA increased from 10.3° ±1.0° preoperatively to 11.2° ±0.9°. The JOA score in the curvature reconstruction group improved from(10.8±0.7)preoperatively to(15.0±0.5), with an improvement rate of(68.3±7.1)%; CLA increased from 10.4°±0.8° preoperatively to 14.7°±1.2°.At 3 months postoperatively, there were statistically significant differences between the two groups in JOA score, JOA score improvement rate, CLA, and the proportion of patients experiencing axial symptoms(P<0.05), while the proportion of patients experiencing head lift weakness showed no statistically significant difference(P>0.05). Conclusions: Intraoperative adjustment of cervical curvature and muscle reconstruction in double-opening vertebroplasty effectively improves postoperative CLA and alleviates clinical symptoms in OPLL patients with K-lines(-) in the standard position and K-lines(+) in the extension position.更多还原