前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症-代发表论文|医学

目的探讨采用前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症的适应证、方法及其临床效果.方法2006年4月至2008年3月,25例严重颈椎后纵韧带骨化症患者采用前路多节段椎体次全切除手术进行治疗,年龄42～75岁,平均53.2岁.骨化物分型包括局限型7例,分节型5例,连续型8例,混合型5例;骨化物范围涉及2～4个椎节,平均2.8个椎节;椎管狭窄率50～97,平均68.4.所有患者均通过前路椎体次全切除术,切除骨化后纵韧带减压,并采用钛网植骨钢板固定重建颈椎稳定性.结果本组两椎体次全切除16例,三椎体次全切除9例.随访2～18个月,患者神经功能JOA评分从术前平均9.3(5～12)分提高至术后平均14.2(11～16)分,恢复率22.2～87.5,平均63.2.并发症包括6例脑脊液漏(4例间歇性脑脊液假性囊肿),2例神经根麻痹,1例血肿压迫,1例术后短期四肢肌力下降.结论前路多椎体次全切除治疗严重颈椎后纵韧带骨化症有助于提高此类患者的手术疗效,但手术难度大,风险高.ObjectiveTodiscussthesurgicalindications,outcomesandcomplicationsofanteriormultilevelcorpoctomyforthetreatmentofsevereossificationofposteriorlongitudinalligament(OPLL)inthecervicalspine.MethodsBetweenApril2006andMarch2008,atotalof25patients(20malesand5females,agerange:42-75yr,mean:53.2yr)underwentanteriormultilevelcorpectomyforsevereossificationofposteriorlongitudinalligamentinthecervicalspine.RadiologicalstudiesshowedthatthetypeofOPLLwasdistributedasfollows:7local,5segmental,8continuousand5mixed.TheOPLLextendedanaverageof2.8vertebrae(2-4)andthestenoticrateofspinalcanalwas68.4(50-97).AftercorpectomyandremovalofOPLL,titaniummeshcageandanteriorplatewereemployedtorestorecervicalstabihtyinallpatients.ResultsAmongthesepatients,16underwenttwo-levelcorpectomyand9three-levelcorpectomy.Afterafollow-upof2-18months,themeanJOAscoreincreasedfrom9.3(5-12)pointspre-operatiento14.2(11-16)pointspost-operation.Themeanimprovementrateofneurologicalstatuswas63.2(22.2-87.5).ThecomplicationsincludedCSFleakagein6cases(intermittentCSFpseudocystin4),nerverootpalsyin2,hematomain1andtransientneurologicaldeteriorationin1.ConclusionAnteriormultilevelcorpextomycanachieveabetterclinicaloutcomeinthetreatmentofseverecervicalossificationofposteriorlongitudinalligament.Butitistechnicallydemandingandcarriesahigherrisk.