| 郑博隆,郝定均,杨小彬,闫亮,惠华,刘仲凯,郭华,程清平,贺宝荣.单开门椎板成形术和椎板切除并侧块螺钉内固定术治疗颈椎后纵韧带骨化症的疗效比较[J].脊柱外科杂志,2018,16(1):14-21. |
单开门椎板成形术和椎板切除并侧块螺钉内固定术治疗颈椎后纵韧带骨化症的疗效比较  点此下载全文 (Fulltext) |
| 郑博隆1 郝定均1 杨小彬1 闫亮1 惠华1 刘仲凯1 郭华1 程清平2 贺宝荣1 |
1. 西安交通大学附属红会医院脊柱外科, 陕西 710054;
2. 韩城市人民医院骨二科, 陕西 715400 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2018.01.004 |
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| 摘要： |
| 目的 比较单开门椎板成形术和椎板切除并侧块螺钉内固定术治疗颈椎后纵韧带骨化症（OPLL）的疗效及术后并发症发生情况，并探究颈椎曲度和矢状面平衡对疗效的影响。方法 回顾性分析2005年1月-2013年12月在西安交通大学附属红会医院行手术治疗的455例多节段OPLL患者资料，其中231例行椎板成形术（A组），224例行椎板切除并侧块螺钉内固定术（B组），手术范围均为C3~7。记录2组患者一般资料及术后并发症发生情况。比较术后各随访时间点的C2~7 Cobb角、颈椎曲度指数（CCI）、C2铅垂线至C7后上缘的距离（C2~7 SVA）、日本骨科学会（JOA）评分、视觉模拟量表（VAS）评分和颈椎功能障碍指数（NDI）。结果 所有患者均获随访，平均随访31.2（27~38）个月。术后24个月，2组C2~7 Cobb角和CCI均较术前明显减小，但2组间差异无统计学意义（P > 0.05）；A组C2~7 SVA较术前明显增高，B组C2~7 SVA无明显变化，2组间相比差异有统计学意义（P < 0.05）。术后24个月，2组JOA评分、VAS评分及NDI较术前均明显改善，2组间JOA评分在各随访时间点差异均无统计学意义（P > 0.05）；VAS评分在术后1个月、3个月、6个月时A组低于B组，差异有统计学意义（P < 0.05），6个月后2组差异无统计学意义（P > 0.05）；NDI在术后1个月、3个月时A组低于B组，差异有统计学意义（P < 0.05），3个月后2组差异无统计学意义（P > 0.05）。共有34例患者发生C5神经根麻痹，其中A组中有11例，B组中有23例，差异有统计学意义（P < 0.05）。结论 椎板成形术尽管在维持颈椎矢状面平衡上不如椎板切除并侧块螺钉内固定术，但两者能获得相似的神经功能恢复。椎板成形术术后轴性痛在短期内低于椎板切除并侧块螺钉内固定术，长期两者无明显差异；椎板成形术术后C5神经根麻痹的发生率较椎板切除并侧块螺钉内固定术低，但患者均能在6个月内恢复。 |
| 关键词：颈椎 骨化,后纵韧带 椎板切除术 内固定器 |
| Comparison of efficacy of laminoplasty and laminectomy combined with lateral mass screw fusion for treatment of cervical ossification of posterior longitudinal ligament Fulltext |
| ZHENG Bo-long1 HAO Ding-jun1 YANG Xiao-bin1 YAN Liang1 HUI Hua1 LIU Zhong-kai1 GUO Hua1 CHENG Qing-ping2 HE Bao-rong1 |
1. Department of Spinal Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, Shaanxi, China;
2. Second Department of Orthopaedics, People's Hospital of Hanchen, Hancheng 715400, Shaanxi, China |
| Fund Project: |
| Abstract: |
| Objective To compare the efficacy of laminoplasty and laminectomy combined with lateral mass screw fusion for treatment of cervical ossification of posterior longitudinal ligament(OPLL),and explore the influence of cervical curvature and sagittal alignment upon clinical outcomes.Methods From January 2005 to December 2013,455 patients with cervical OPLL were retrospectively analyzed,consisting of 231 patients treated by laminoplasty(group A) and 224 by laminectomy combined with lateral mass screw fusion(group B). The extents of surgery were both C3-7. The 2 groups were compared in aspects of C2-7 Cobb's angle,cervical curvature index(CCI),C2-7 sagittal vertical axis(C2-7 SVA) Japanese Orthopaedic Association(JOA) score,visual analogue scale(VAS) score and neck disability index(NDI). The general information of the patients and postoperative complications were recorded.Results All the patients were followed up for 31.2(27-38)months. Compared with pre-operation,C2-7 Cobb's angle and CCI were significantly reduced at 24 months,C2-7 SVA increased in group A,but stayed the same in group B. Intergroup comparison indicated that C2-7 Cobb's angle and CCI showed no statistical difference between the 2 groups(P > 0.05);C2-7 SVA of group A showed no statistical difference with group B(P > 0.05) within 1 month,but higher than group B at each follow-up point afterwards(P < 0.05). JOA score,VAS score and NDI of 2 groups were significantly ameliorated at 24 months(P < 0.05). Intergroup comparison indicated that JOA score showed no statistical difference between 2 groups at each time point of followed-up(P > 0.05);VAS score of group A was lower than that of group B(P < 0.05) at 1,3 and 6 months,but had no statistical difference afterwards(P > 0.05);NDI of group A was lower than that of group B(P < 0.05) at 1 and 3 months,but had no statistical difference afterwards(P > 0.05). A total of 34 patients suffered from C5 palsy,11 in group A and 23 in group B,with statistical difference(P < 0.05).Conclusion Although laminoplasty is inferior to laminectomy combined with lateral mass screw fusion in maintaining sagittal balance,but both can acquire similar neurological recovery. The axial pain after laminoplasty is milder than laminectomy combined with lateral mass screw fusion in the short term,but both are similar in the long term. The incidence of C5 palsy after laminoplasty is lower than that after laminectomy combined with lateral mass screw fusion,which will recover in 6 months. |
| Keywords:Cervical vertebrae Ossification of posterior longitudinal ligament Laminectomy Internal fixators |
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