【摘要】 目的应用改良前路减压术治疗颈椎后纵韧带骨化,并分析其疗效。方法颈椎后纵韧带骨化症42例134个骨化节段,其中连续型35例122个节段,跳跃型4例9个节段,局限型3例3个节段。术前CT检查骨化灶厚度指数(O-Index)为12.4%～78.8%,平均43.2%。手术经颈前路于椎体开槽,深至椎体后缘时用微型磨钻向骨化灶边缘游离。处理与硬膜严重粘连不宜切除的骨化灶时,可用丝线缝穿骨化灶一侧残余的后纵韧带或骨化灶周围的纤维组织,轻轻提起系在植骨块或颈长肌上,使骨化灶完全缩入骨槽内;对体积较小、与硬膜粘连轻的骨化灶予以切除。结果全部病例随访1年6个月～8年,平均3年8个月。按JOA标准评估神经功能,术前轻度神经功能障碍(13～16分)28例,术后平均改善率74%;中度(8～12分)11例,术后改善率75%;重度(< 7分)3例,术后改善率78%。CT显示42例84个节段骨化灶前移至骨槽内,椎管内径恢复正常。术中神经症状一过性加重2例,脑脊液漏12例,术后骨化灶残留6例9节段,无术后死亡及瘫痪加重病例。结论应用骨化灶游离前移治疗颈椎后纵韧带骨化相对安全,减压彻底,可减少脊髓损伤并发症发生,使神经功能获得最大程度恢复,对于骨化灶厚度指数在80%以下者均可考虑行前路减压。更多还原

【Abstract】 Objective To evaluate the clinical result of modified anterior decompression for the treatment of cervical myelopathy due to ossification of posterior longitudinal ligament(OPLL). Methods From April 1994 to October 2002, 42 cases of OPLL involving 134 cervical segments were operated using modified anterior decompression, among them there were 35 cases, 122 segments of the continuous type; 4 cases, 9 segments of the mixed type; 3 cases, 3 segments of the solitary type. The preoperative index of thickness (O-Index) ranged from 12.4%-78.8%, with an average of 43.2%. A slot was made in the vertebral body through anterior approach and bilateral border of the ossification was dissected from the posterior wall of vertebral body with burr-drill. Results The average follow-up was 3 years and 8 months ranging from 1 year and 6 months to 8 years. The recovery of neurologic function was evaluated according to JOA score: 28 cases with mild neurologic deficit (13-16 points) improved on average 74% postoperatively; 11 cases of the moderately damaged group (8-12 points) improved on 75%; 3 cases of the severely damaged group (< 7 points) improved on 78%. Ossified focus of 84 segments in 42 cases shifted anteriorly into the slot formed in the vertebral body. The internal diameter of spinal canal restored to normal on postoperative CT scans. 2 cases experienced neurologic deterioration during surgery, one recovered 5 min later, the other 2 h later. Cerebral spinal fluid leakage occurred in 12 cases. With fatty patch repair, the leakage stopped 3-5 d later in 11 and 13 d later in 1. No death or deterioration of neurological deficit occurred. Conclusion The modified anterior decompression is proved to be safe and effective in treating ossification posterior longitudinal ligament in terms of the lower rate of neurological complication and the satisfactory recovery of neurological function.更多还原