颈后路单开门椎管成形术和全椎板减压术治疗多节段颈椎后纵韧带骨化症效果比较
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摘要
目的比较颈后路单开门椎管成形术与全椎板切除减压术治疗多节段颈椎后纵韧带骨化症(OPLL)的临床效果。方法选择2014年8月至2016年8月新乡医学院第一附属医院骨外二科收治的因多节段颈椎OPLL行手术治疗的患者66例,根据手术方式分为行全椎板切除减压术的对照组(n=30)和行单开门椎管成形术的观察组(n=36)。分别于术前及术后24个月采用日本骨科学会(JOA)评分评估患者神经功能,采用视觉模拟量表(VAS)评估患者术前及术后24个月时颈背部的轴性疼。影像学检查观测2组患者的颈椎曲度指数(CCI)、颈椎活动度(ROM)、颈椎矢状平衡指数(C2-7SVA),并观察2组患者术后并发症发生情况。结果 2组患者术前JOA、VAS评分比较差异无统计学意义(P> 0. 05)。术后24个月,2组患者JOA评分较术前显著提高(P <0. 05),VAS评分较术前显著降低(P <0. 05)。术后24个月,2组患者JOA、VAS评分比较差异无统计学意义(P> 0. 05)。2组患者术前CCI、C2～7SVA、ROM比较差异均无统计学意义(P> 0. 05)。术后24个月,2组患者CCI低于术前,观察组患者CCI低于对照组(P <0. 05),2组患者CCI丢失量比较差异无统计学意义(P> 0. 05)。术后24个月,2组患者ROM低于术前(P <0. 05),观察组患者ROM显著高于对照组(P <0. 05),观察组患者ROM丢失度显著低于对照组(P <0. 05)。术后24个月,2组患者C2～7SVA高于术前(P <0. 05),观察组患者C2～7SVA显著高于对照组(P <0. 05),观察组患者C2～7SVA增加量高于对照组(P <0. 05)。术后随访24个月,对照组患者发生切口感染2例(6. 7%),脑脊液漏3例(10. 0%),轴性症状6例(20. 0%),第5颈神经根麻痹7例(23. 3%),并发症总发生率为60. 0%(18/30);观察组患者发生切口感染3例(8. 3%),脑脊液漏3例(8. 3%),轴性症状1例(2. 8%),第5颈神经根麻痹2例(5. 6%),并发症总发生率为25. 0%(9/36);观察组患者轴性症状、第5颈神经根麻痹发生率及并发症总发生率低于对照组(χ2=5. 119、4. 391、0. 829,P <0. 05)。结论颈后路单开门椎管成形术与全椎板切除减压术治疗多节段颈椎OPLL均可获得较为满意的临床恢复效果,单开门椎管成形术在维持颈椎曲度及颈椎矢状位平衡方面不如全椎板切除减压融合术,但椎管成形术术后保留颈椎活动度更大,且轴性症状、第5颈神经根麻痹发生率较低。
Objective To compare the clinical effect of posterior single-door laminoplasty and total laminectomy for treatment of ossification of the posterior longitudinal ligament( OPLL). Methods Sixty-six multilevel cervical spine OPLL patients who underwent operation treatment in the First Affiliated Hospital of Xinxiang Medical University from August 2014 to August 2016 were selected and divided into observation group( n = 36) and control group( n = 30). The patients in the control group were given total laminectomy,the patients in the observation group were given single-door laminoplasty. The neurological function of patients in the two groups was evaluated by Japanese Orthopaedic Association( JOA) score at before and 24 months after operation; the axial pain of the neck of patients in the two groups was evaluated by visual analog scale( VAS) before and24 months after operation. The cervical curvature index( CCI),range of motion( ROM) and C2-7 sagittal vertical axis( C2-7 SVA) were detected by maging examination. The postoperative complications of patients in the two groups were observed compared. Results There was no significant difference in the JOA and VAS scores between the two groups before operation( P > 0. 05). The JOA score of patients at 24 months after operation was significantly higher than that before operation,but the VAS score was significantly lower than that before operation in the two groups( P < 0. 05). There was no significant difference in the JOA and VAS scores between the two groups at 24 months after operation( P > 0. 05). There was no statistic difference in the CCI,C2-7 SVA and ROM between the two groups before operation( P > 0. 05). At 24 months after operation,the CCI of patients in the two groups was significantly lower than before operation and the CCI of patients in the observation group was lower than that in the control group( P < 0. 05). There was no significant difference in the CCI loss between the two groups( P > 0. 05). At 24 months after operation,the ROM of patients in the two groups was significantly lower than before operation( P < 0. 05) and the ROM of patients in the observation group was significantly higher than that in the control group( P <0. 05). The ROM loss of patients in the observation group was significantly lower than that in the control group( P < 0. 05). At24 months after operation,the C2-7 SVA of patients in the two groups was significantly higher than before operation( P < 0. 05)and the C2-7 SVA of patients in the observation group was higher than that in the control group( P < 0. 05). The increase of C2-7 SVA of patients in the observation group was higher than that in the control group( P < 0. 05). During 24 months followed up,there were 2( 6. 7%) cases of incision fections,3( 10. 0%) cases of cerebrospinal fluid leakage,6( 20. 0%) cases of axial symptoms and 7( 23. 3%) cases of C5 nerve root palsy in the control group,and the total incidence of complications was60. 0%( 18/30); in the observation group,there were 3( 8. 3%) cases of incision infections,3( 8. 3%) cases of cerebrospinal fluid leakage,1( 2. 8%) case of axial symptoms and 2( 5. 6%) cases of C5 nerve root palsy and the total incidence of complications was 25. 0%( 9/36). The axial symptoms,the incidence of C5 nerve root palsy and the total incidence of complications in the observation group were lower than those in the control group( χ2= 5. 119,4. 391,0. 829; P <0. 05). Conclusion Posterior cervical single-door laminoplasty and total laminectomy for the treatment of OPLL can achieve satisfying clinical effect. Total laminectomy is better than single-door laminoplasty in maintaining cervical curvature and sagittal position,but posterior single-door laminoplasty has greater mobility after surgery,and the incidence of axial symptoms and C5 nerve root palsy is lower.
Objective To compare the clinical effect of posterior single-door laminoplasty and total laminectomy for treatment of ossification of the posterior longitudinal ligament( OPLL). Methods Sixty-six multilevel cervical spine OPLL patients who underwent operation treatment in the First Affiliated Hospital of Xinxiang Medical University from August 2014 to August 2016 were selected and divided into observation group( n = 36) and control group( n = 30). The patients in the control group were given total laminectomy,the patients in the observation group were given single-door laminoplasty. The neurological function of patients in the two groups was evaluated by Japanese Orthopaedic Association( JOA) score at before and 24 months after operation; the axial pain of the neck of patients in the two groups was evaluated by visual analog scale( VAS) before and24 months after operation. The cervical curvature index( CCI),range of motion( ROM) and C2-7 sagittal vertical axis( C2-7 SVA) were detected by maging examination. The postoperative complications of patients in the two groups were observed compared. Results There was no significant difference in the JOA and VAS scores between the two groups before operation( P > 0. 05). The JOA score of patients at 24 months after operation was significantly higher than that before operation,but the VAS score was significantly lower than that before operation in the two groups( P < 0. 05). There was no significant difference in the JOA and VAS scores between the two groups at 24 months after operation( P > 0. 05). There was no statistic difference in the CCI,C2-7 SVA and ROM between the two groups before operation( P > 0. 05). At 24 months after operation,the CCI of patients in the two groups was significantly lower than before operation and the CCI of patients in the observation group was lower than that in the control group( P < 0. 05). There was no significant difference in the CCI loss between the two groups( P > 0. 05). At 24 months after operation,the ROM of patients in the two groups was significantly lower than before operation( P < 0. 05) and the ROM of patients in the observation group was significantly higher than that in the control group( P <0. 05). The ROM loss of patients in the observation group was significantly lower than that in the control group( P < 0. 05). At24 months after operation,the C2-7 SVA of patients in the two groups was significantly higher than before operation( P < 0. 05)and the C2-7 SVA of patients in the observation group was higher than that in the control group( P < 0. 05). The increase of C2-7 SVA of patients in the observation group was higher than that in the control group( P < 0. 05). During 24 months followed up,there were 2( 6. 7%) cases of incision fections,3( 10. 0%) cases of cerebrospinal fluid leakage,6( 20. 0%) cases of axial symptoms and 7( 23. 3%) cases of C5 nerve root palsy in the control group,and the total incidence of complications was60. 0%( 18/30); in the observation group,there were 3( 8. 3%) cases of incision infections,3( 8. 3%) cases of cerebrospinal fluid leakage,1( 2. 8%) case of axial symptoms and 2( 5. 6%) cases of C5 nerve root palsy and the total incidence of complications was 25. 0%( 9/36). The axial symptoms,the incidence of C5 nerve root palsy and the total incidence of complications in the observation group were lower than those in the control group( χ2= 5. 119,4. 391,0. 829; P <0. 05). Conclusion Posterior cervical single-door laminoplasty and total laminectomy for the treatment of OPLL can achieve satisfying clinical effect. Total laminectomy is better than single-door laminoplasty in maintaining cervical curvature and sagittal position,but posterior single-door laminoplasty has greater mobility after surgery,and the incidence of axial symptoms and C5 nerve root palsy is lower.
引文
[1]EPSTEIN N.Ossification of the cervical posterior longitudinal ligament:a review[J].Neurosurg Focus,2002,13(2):176-180.
[2]韦敏克,尹东,梁斌,等.颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究[J].中国矫形外科杂志,2014,22(19):1751-1755.
[3]LI J,ZHANG Y,ZHANG N,et al.Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line-in the neck neutral position but K-line+in the neck extension position:a retrospective observational study[J].Medicine,2017,96(22):e6964.
[4]SOO M Y,RAJARATNAM S.Symptomatic ossification of the posterior longitudinal ligament of the cervical spine:pictorial essay[J].Australas Radiol,2015,44(1):14-18.
[5]SMITH J S,LAFAGE V,RYAN D J,et al.Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume:analysis of 56 preoperative cases from the AOSpine North America Myelopathy study[J].Spine,2013,38(22 Suppl1):S161-S170.
[6]TANG J A,SCHEER J K,SMITH J S,et al.The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery[J].Spine J,2012,12(9):S65.
[7]CHEN Y,YANG L,LIU Y,et al.Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament[J].PLoS One,2014,9(7):e102008.
[8]FUJIYOSHI T,YAMAZAKI M,KAWABE J,et al.A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament:the K-line[J].Spine,2008,33(26):E990.
[9]SHIN J H,STEINMETZ M P,BENZEL E C,et al.Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament:considerations for approach selection and review of surgical outcomes[J].Neurosurg Focus,2011,30(3):E8.
[10]SAKAI K,OKAWA A,TAKAHASHI M,et al.Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament:a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty[J].Spine,2012,37(5):367-376.
[11]HIGHSMITH J M,DHALL S S,JR H R,et al.Treatment of cervical stenotic myelopathy:a cost and,outcome comparison of laminoplasty versus laminectomy,and lateral mass fusion[J].JNeurosurg Spine,2011,14(5):619-625.
[12]YANG L,GU Y,SHI J,et al.Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy[J].Orthopedics,2013,36(1):e79-e87.
[13]DUAN Y,ZHANG H,MIN S X,et al.Posterior cervical fixation following laminectomy:a stress analysis of three techniques[J].Eur Spine J,2011,20(9):1552-1559.
[14]RHEE J M,REGISTER B,HAMASAKI T,et al.Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J].Spine,2011,36(1):9-14.
[15]YUAN W,ZHU Y,LIU X,et al.Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament:cervical laminoplasty versus laminectomy with fusion[J].Clin Neurol Neurosurg,2015,134:17-23.
[16]巩腾,苏学涛,夏群,等.颈椎管单开门扩大成形术后轴性痛并发症原因分析[J].中国骨伤,2018,31(1):23-29.
[17]YANG L,GU Y,SHI J,et al.Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy[J].Orthopedics,2013,36(1):E79-E87.
[18]LEE S E,CHUNG C K,JAHNG T A,et al.Long-term outcome of laminectomy for cervical ossification of the posterior longitudinal ligament[J].J Neurosurg Spine,2013,18(5):465-471.
[19]LIU T,KONG J,ZOU W,et al.The correlation study of C5nerve root palsy and common body position in posterior total laminectomy decompression and instrumentation[J].Turk Neurosurg,2016,26(2):280-285.
[2]韦敏克,尹东,梁斌,等.颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究[J].中国矫形外科杂志,2014,22(19):1751-1755.
[3]LI J,ZHANG Y,ZHANG N,et al.Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line-in the neck neutral position but K-line+in the neck extension position:a retrospective observational study[J].Medicine,2017,96(22):e6964.
[4]SOO M Y,RAJARATNAM S.Symptomatic ossification of the posterior longitudinal ligament of the cervical spine:pictorial essay[J].Australas Radiol,2015,44(1):14-18.
[5]SMITH J S,LAFAGE V,RYAN D J,et al.Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume:analysis of 56 preoperative cases from the AOSpine North America Myelopathy study[J].Spine,2013,38(22 Suppl1):S161-S170.
[6]TANG J A,SCHEER J K,SMITH J S,et al.The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery[J].Spine J,2012,12(9):S65.
[7]CHEN Y,YANG L,LIU Y,et al.Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament[J].PLoS One,2014,9(7):e102008.
[8]FUJIYOSHI T,YAMAZAKI M,KAWABE J,et al.A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament:the K-line[J].Spine,2008,33(26):E990.
[9]SHIN J H,STEINMETZ M P,BENZEL E C,et al.Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament:considerations for approach selection and review of surgical outcomes[J].Neurosurg Focus,2011,30(3):E8.
[10]SAKAI K,OKAWA A,TAKAHASHI M,et al.Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament:a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty[J].Spine,2012,37(5):367-376.
[11]HIGHSMITH J M,DHALL S S,JR H R,et al.Treatment of cervical stenotic myelopathy:a cost and,outcome comparison of laminoplasty versus laminectomy,and lateral mass fusion[J].JNeurosurg Spine,2011,14(5):619-625.
[12]YANG L,GU Y,SHI J,et al.Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy[J].Orthopedics,2013,36(1):e79-e87.
[13]DUAN Y,ZHANG H,MIN S X,et al.Posterior cervical fixation following laminectomy:a stress analysis of three techniques[J].Eur Spine J,2011,20(9):1552-1559.
[14]RHEE J M,REGISTER B,HAMASAKI T,et al.Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J].Spine,2011,36(1):9-14.
[15]YUAN W,ZHU Y,LIU X,et al.Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament:cervical laminoplasty versus laminectomy with fusion[J].Clin Neurol Neurosurg,2015,134:17-23.
[16]巩腾,苏学涛,夏群,等.颈椎管单开门扩大成形术后轴性痛并发症原因分析[J].中国骨伤,2018,31(1):23-29.
[17]YANG L,GU Y,SHI J,et al.Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy[J].Orthopedics,2013,36(1):E79-E87.
[18]LEE S E,CHUNG C K,JAHNG T A,et al.Long-term outcome of laminectomy for cervical ossification of the posterior longitudinal ligament[J].J Neurosurg Spine,2013,18(5):465-471.
[19]LIU T,KONG J,ZOU W,et al.The correlation study of C5nerve root palsy and common body position in posterior total laminectomy decompression and instrumentation[J].Turk Neurosurg,2016,26(2):280-285.