颈椎高位后纵韧带骨化单开门成形颈后肌重附着

Unilateral open-door laminoplasty combined with reattachment of posterior muscle for upper cervical ossification of poste⁃ rior longitudinal ligament

摘要:

［目的］介绍颈椎高位后纵韧带骨化症（ossification of posterior longitudinal ligament, OPLL）单开门成形和肌肉止点重建的手术技术和初步临床效果。［方法］2015 年 3 月—2019 年 3 月对 16 例多节段累及 C2及以上椎体的 OPLL 患者行颈后路单开门椎管扩大成形术加颈后肌肉重建术。显露 C_1~7双侧椎板及椎间关节，咬平 C_2~7棘突，C_4、6棘突基底部打孔，于 C_3~7双侧做一骨槽，左侧仅切除外板，右侧切除全板，将 C_3~7椎板自右侧向左侧整体掀开约 1.5 cm，用微型钛板固定 C_3、5、7椎板于相应右侧块，C_4、6用丝线固定。切除 C₂椎板，于 C₂双侧椎弓根置入螺钉，横向置入预弯钢板，切除寰椎后弓，颈后肌肉缝合固定于 C₂ 钢板上重建肌肉起点。［结果］所有患者均顺利完成手术，末次随访 VAS 和 JOA 评分均较术前显著改善（P<0.05）。末次随访颈椎活动度较术前无明显变化（P>0.05）。［结论］ 颈后路单开门椎管扩大成形术加颈后肌肉重建能够有效缓解临床症状，避免术后出现抬头无力现象，对多节段高位 OPLL 治疗效果良好。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of unilateral open-door laminoplasty com- bined with reattachment of posterior muscle for upper cervical ossification of posterior longitudinal ligament (OPLL) . [Methods] From March 2015 to March 2019, 16 patients with multiple levels of OPLL involving C₂ or upper underwent unilateral open-door laminoplasty combined with reattachment of posterior muscle. After exposing C_1~7 bilateral lamina and facets, the C_1~7 spine processes were removed with holes punched on base of C₄ and C₆. Bilateral bone slots on C_3~7 were made, with total bone removed on the right side, while outer bone corti- cal removed on the left side. Subsequently, the lamina in a whole was carefully raised on the right side about 1.5 cm, and fixed with mini tita- nium plate on C₃, C₅ and C₇, while suture tie on the C₄ and C₆. The C₂ total laminectomy was conducted, and bilateral pedicle screws were in- serted with a transvers plate fixed on the C₂. Finally, the posterior cervical muscle was sutured on the C₂ plate to reconstruct the attachment of the muscle. [Results] All the patients had operation performed successfully. At the latest follow up, the VAS and JOA scores significantly improved compared with those preoperatively (P＜0.05) , while the cervical range of motion remained unchanged significantly (P＞0.05) . [Conclusion] This unilateral open- door laminoplasty combined with reattachment of posterior muscle does effectively relieve the clinical symptoms, avoid postoperative head-up weakness, and achieve satisfactory clinical outcomes for upper cervical OPLL.