【作者】 谭明；

【导师】 赵明杰；

【作者基本信息】 暨南大学 ， 外科学， 2012， 硕士

【摘要】 目的：对比分析颈前路椎体次全切、骨化灶切除或部分切除、钛网植骨融合内固定术，后路单开门减压椎管成形、椎体侧块内固定术，后路单开门椎管成形术三种手术治疗长节段颈椎后纵韧带骨化症（Cervical Ossification of the Posterior Longitudinal Ligament，OPLL）的手术效果及并发症，探讨治疗长节段OPLL的较优手术方式，为临床治疗提供参考。方法：回顾分析2006年1月至2011年1月间在暨南大学附属第一医院、湘雅医学院附属第二医院、南华大学附属第三医院手术治疗54例颈椎长节段OPLL患者，其中男24例，女30例，年龄41-78岁，平均65.4岁，行颈前路椎体次全切、骨化灶切除或部分切除、钛网植骨融合内固定术者20例（前路组），后路单开门减压椎管成形、椎体侧块内固定术者26例（后路内固定组），后路单开门椎管成形术者8例（后路无内固定组）。平均随访时间2.4年(6月-5年)。所有患者术前均常规进行颈椎X线正侧位、CT平扫及MRI检查。术后1周、1年随访行颈椎X线正侧位片检查，部分患者加行CT矢状位重建检查。术后疗效采用日本骨科学会JOA评分系统进行评价，同时计算早期及终末JOA改善率,JOA改善率=（术后评分-术前评分）/（17-术前评分）×100%。采用SPSS13.O统计分析软件统计学分析术前术后JOA改善率情况，P<0.05差异具有显著性。观察三组患者术后恢复情况，同时分析影响手术效果的因素。结果：前路组、后路内固定组、后路无内固定组三种手术治疗后术后1周时JOA改善率分别为51.04%、70.87%、65.73%，各组两两比较，两组后路手术之间JOA改善率无明显差异，但都优于前路；术后1年左右时，三组病例JOA改善率分别为75.87%、78.90%、76.94%，各组两两比较，均无明显差异。治疗后前路组并发症有脑脊液漏1例，喉返神经损伤1例，血肿形成1例，颈动脉窦损伤1例；后路内固定组1例患者术中并发脑脊液漏，1例患者术后出现C5神经根症状；后路无内固定组有2例患者出现轴索症状，1例患者术后1年查发现椎板继发关门。结论：1、治疗长节段颈椎后纵韧带骨化症采用前路椎体次全切钛网植骨融合内固定术、后路单开门椎管成形内固定术、后路单开门椎管成形术三种术式均可获得较好的疗效。2、术后短期内后路单开门椎管成形内固定术、后路单开门椎管成形术术后JOA改善率优于前路椎体次全切钛网植骨融合内固定术；术后1年左右三种术式的术后JOA改善率无明显差异。3、前路椎体次全切钛网植骨融合内固定术、后路单开门椎管成形内固定术、后路单开门椎管成形术三种术式治疗长节段颈椎后纵韧带骨化症比较，颈后路单开门椎管成形内固定术具有并发症少，风险小，安全有效的特点，是治疗该病的一种较好方法。更多还原

【Abstract】 OBJECTIVE:To discuss and analyze three kinds of surgical (Anterior cervicalcorpectomy,removal or partial removal of ossification foci,interbody implantfusion;Posterior open-door laminoplasty,decompression,bone graft and internalfixation;Posterior open-door laminoplasty) treatments effect on long-segment cervicalossification of the posterior longitudinal ligament.It could provide a reference foroperative select.METHODS: It was a retrospective analysis of the54cases of ossification of theposterior longitudinal ligament of clinical data，that was collected in the The first hospitalaffiliated Jinan university,Second Xiangya Hospital, The Affiliated Hospital of NanhuaUniversity during the time Jan.2006-Jan.2010.Age of41to78years，average65.5yearsold,which involved24men and30women.20cases undergoing anterior cervicalcorpectomy,removal or partial removal of ossification foci,interbody implant fusion asgroup A,26receiving posterior open-door laminoplasty,decompression,bone graft andinternal fixation as group B,and8undergoing posterior open-door laminoplasty withoutinternal fixation as group C.Patients were followed up for6months to5years,2.4yearson average.Lateral cervical spine X-ray,CT scan and MRI examinations were routinelytaken preoperatively.Results of operations according to JOA scoring system,which wasformulated by Japanese Orthopaedic Association,were evaluated.Neurological functionwas evaluated on preoperatively,and lw,ly postoperatively,and the improvementrates were also calculated.The data was evaluated by SPSS l3.0analysis software.The difference was statistical significance when P<0.05. Surgical complications and factorsaffecting the surgical results were also recorded.Results:1week after treatment,the mean amelioration rate was51.04%in groupA,70.87%in group B,65.73%in group C.There was1case with dural tear in group A,there have significant difference between anterior and posterior approach,and but therewas no significant difference between Group B and Group C.1year after treatment,themean amelioration rate was75.87%in group A,78.90%in group B,76.94%in group C,there was no significant difference between each Group.There was1case with duraltear in group A,1case of recurrent laryngeal nerve temporary palsy occurred,1casehad Hematoma,and1case got Carotid sinus injury; In group B,1case had dural tear,1case had C5nerve root palsy; In group C, posterior axis of symptoms occurred in2cases,1case of Lamina secondary closed.Conclusion:1.Use anterior cervical corpectomy,removal or partial removal ofossification foci,interbody implant fusion and posterior open-door laminoplasty,decompression,bone graft and internal fixation and posterior open-door laminoplastytreat long-segment OPLL, three procedures are given a good effect;2.Short-termfollow-up to improve the rate of anterior and posterior surgical procedure have differencebetween anterior and posterior approach,but1year after treatment, the amelioration ratewas no significant difference between each methods;3. For long-segmentOPLL,posterior open-door laminoplasty, decompression,bone graft and internal fixationwith few complications,it safe and effective.更多还原