颈椎上胸椎后纵韧带骨化单开门椎管成形

Single open- door laminoplasty for ossification of posterior longitudinal ligament in cervical and upper thoracic spine

摘要:

[目的]探讨后路单开门椎管成形术治疗颈椎联合上胸椎串联后纵韧带骨化症(ossification of posterior longitudinal lig- ament, OPLL) 的临床效果。[方法] 2015 年 5 月—2019 年 2 月对 21 例颈椎联合上胸段 OPLL 患者一期行单开门椎管成形手术治疗。[结果]所有病例均顺利完成手术，未出现脑脊液漏、硬膜外血肿等严重并发症。所有患者术后随访 9~24 个月。随时间推移，患者的锥体束征、JOA、VAS、NDI 评分均显著改善(P＜0.05)。其中 1 例患者出现较严重 C5神经根麻痹症状，经对症处理后缓解。影像方面，与术前相比，术后 6 个月及末次随访时患者颈椎前凸角减小，但差异无统计学意义(P＞0.05)，而椎管矢状径显著增加(P＜0.05)。随访期间未出现再关门及门轴断裂等情况。[结论] 后路单开门椎管扩大成形术治疗颈椎上胸椎串联后纵韧带骨化症可达到充分的脊髓减压，获得满意神经功能改善，并发症低，临床疗效满意。

Abstract:

[Objective] To explore the clinical outcomes of single open-door laminoplasty for ossification of the posterior longitudinal ligament (OPLL) in cervical and upper-thoracic spine. [Methods] From May 2017 to February 2019, a total of 21 patients underwent single open- door laminoplasty for continuous OPLL in cervical and upper- thoracic spine. [Results] All the patients had operation completed smoothly without serious complications, such as cerebrospinal fluid leakage and epidural hematoma. As time went during the follow-up last- ed for 9~24 months, the pyramidal tract sign, JOA, VAS and NDI scores significantly improved (P＜0.05) . One patient developed severe C5 nerve palsy, which was relieved after symptomatic treatment. In terms of imaging, the cervical lordosis angle decreased at 6 months after op- eration and at the latest follow-up compared with that preoperatively, but the difference was not statistically significant (P＞0.05) , while the sagittal diameter of the spinal canal increased significantly (P＜0.05) . During the follow-up period, no reclosing and the shaft fracture were noted in anyone of them. [Conclusion] Single posterior open-door extended laminoplasty does achieve sufficient spinal cord decompression, satisfactory neurological function improvement with low complications and satisfactory clinical efficacy for continuous OPLL in cervical and upper-thoracic spine.