生物骨科材料与临床研究2018，Vol.15Issue(3)：18-22,28,后插3,7.DOI:10.3969/j.issn.1672-5972.2018.03.005
延伸至上颈椎的颈椎后纵韧带骨化的治疗策略
Surgical strategy of the ossification of the posterior longitudinal ligament expansive to upper cervical spine
马立泰 1刘浩 1黄康康 1王贝宇 1邓宇骁 1丁琛 1陈华 1戎鑫1
作者信息
- 1. 四川大学华西医院,四川 成都,600041
- 折叠
摘要
Abstract
Objective To explore the surgical strategy of the ossification of posterior longitudinal ligament expansive to the upper cervical spine. Methods A retrospective analysis was performed in 39 patients with ossification expansive to the up over the level of C2/3 disc, with satisfying data and with follow-up from 460 cases who were suffered with ossification of the posterior longitudinal ligament in cervical spine from May 2010 to Mar 2017. In all 39 cases, there were 9 cases be operated by unilateral open-door laminoplasty (1st operative method), 3 cases by unilateral open-door laminoplasty and undermining decompression at C2 laminate inferior margin (2nd operativemathod), 22 cases by unilateral open-door laminoplasty and C2 semi-laminectomy undermining decompression (3rd operative mathod), 5 cases by C2-6 or C2-7 unilateral open-door laminoplasty (4rd operative mathod). All the patients had preoperative, postoperative and followup plain radiographs, computed tomography (CT) scans, and magnetic resonance images (MRI). The cervical lordosis, cervical range of motion (ROM), the ossified mass occupying ratio at the level of C2, presence or absence of images of cerebrospinal fluid (CSF) at the level of C2/3 disc and C2 body inMRI T2WI, JOA and improvement rate(IR) were used to assess clinical outcomes. Results In all 39 cases, there were 13 cases whose OPLL up to C2/3 disc level and 26 cases whose OPLL up to C2 body level. Pre-operatively, all the cases absent the images of CSF in MRI T2WI. The absence segment in the front of spinal cord was 3-6 and the absence segment behind spinal cord was 1-6. Post-operatively, the data was 0-4 and 0-5 in just 8 cases. There was significant difference between pre- and post- operative absent the images of CSF of in the front of and behind the spinal cord (P=0. 000, P=0. 000). In the 1st operative method group, 4 cases still absent the images of CSF in MRI T2WI in 9 cases, however, in the 2nd, 3rd, and 4th operative method groups there were only 4 cases in 30 cases. There was significant difference between the two groups about the range of absence images of CSF in MRI T2WI in the front of or behind the spinal cord post-operatively (P=0. 038;P=0. 042). The follow-up was 4-17 months. The last follow-up JOA score was 12. 03±3. 71 (range 4-17), the pre-operative JOA was 6. 85±3. 35 (3-13), the recovery rate was 57％±27％ (range 7-100％). The three parameters were no significant difference between the two groups. Conclusion The depression should be done to C2 level when a patient's ossification of the posterior longitudinal ligament expansive to up over the level of C2/3 disc. C2 semi-laminectomy undermining decompression and unilateral open-door laminoplasty to C2 level was a good surgical method in which images of CSF in MRI T2WI of in the front of and behind the spinal cord turn better after depression.关键词
颈椎后纵韧带骨化/上颈椎/单开门椎管扩大成形术/预防/椎管减压Key words
OPLL/Upper cervical spine/Unilateral open-door laminoplasty/Prevention/Depression分类
医药卫生引用本文复制引用
马立泰,刘浩,黄康康,王贝宇,邓宇骁,丁琛,陈华,戎鑫..延伸至上颈椎的颈椎后纵韧带骨化的治疗策略[J].生物骨科材料与临床研究,2018,15(3):18-22,28,后插3,7.
