摘要
目的探讨颈椎后路棘突悬吊式椎管扩大椎板成形术治疗K线阳性后纵韧带骨化症(OPLL)患者K线后移程度与手术疗效之间的相关性。方法回顾性分析2014年1月—2015年12月本院骨科收治的62例K线(+)OPLL患者的临床资料,所有患者均行颈椎后路棘突悬吊式椎管扩大椎板成形术。将椎管最狭窄处骨化块与K线之间的垂直距离定义为KM值,用以量化K线的位置,并用手术前后KM的差值(ΔKM)表示K线的移动程度。比较患者ΔKM值、手术前后C_(2~7) Cobb角的差异。根据患者ΔKM平均值将患者分为A组(ΔKM高于平均值)和B组(ΔKM低于平均值),比较2组患者年龄、手术时间、随访时间、手术前后C_(2~7) Cobb角、日本骨科学会(JOA)评分及JOA改善率。应用Pearson相关性分析探讨所有患者ΔKM值与JOA评分改善率之间的相关性。结果所有患者术后KM值均较术前增加,即K线后移;手术前后C_(2~7) Cobb角无明显变化。2组手术前后C_(2~7) Cobb角、手术时间及随访时间差异无统计学意义(P>0.05);A组患者年龄明显低于B组,差异有统计学意义(P<0.05);排除年龄影响后,A组患者术后JOA评分、JOA评分改善率高于B组,差异有统计学意义(P<0.05);且ΔKM值与JOA评分改善率之间呈正相关。结论颈椎后路棘突悬吊式椎管扩大椎板成形术可有效改善OPLL患者临床症状,其机制可能是C_2、T_1处潜行减压后K线后移。
Objective To investigate the correlation between the posterior shift of the K-line and the outcome of laminoplasty with reattachment of the spinous process for ossification of the posterior longitudinal ligament(OPLL). Methods From 2014 to 2015,62 patients with K-line(+) OPLL underwent laminoplasty were included in the study. The KM was defined as a vertical interval from the ossified mass at the most narrow level of the spinal canal to the K-line. The KM not only can quantify the K-line,but also present the change of K-line pre-and postoperation(ΔKM). The pre-and postoperative C_(2-7) Cobb's angle and ΔKM value were compared in all the patients. Patients were divided into 2 groups depending on the mean value of the ΔKM of all patients :in group A,the ΔKM was greater than mean value;in group B,the ΔKM was less than the mean value. Age,operative time,follow-up time,recovery rate of Japanese Orthopaedic Association(JOA) score,pre-and postoperative C_(2-7) Cobb's angle were compared between the 2 groups. The ΔKM value and recovery rate of JOA was analyzed by Pearson correlation analysis. Results After operation,the KM value of all patients was increased than that before operation,which indicated that the K-line shift posteriorly. There was no significant change in the C_(2-7) Cobb's angle before and after the operation. Pre-and postoperative C_(2-7) Cobb's angle,operative time and follow-up time showed no significantly difference between the 2 groups(P > 0.05). Age of patients in group A was lower than that of group B,and the difference was statistically significant(P < 0.05). Except the influence of age,postoperative JOA scores and the recovery rate of JOA score of patients in group A were higher than that in group B,and the difference was statistically significant(P < 0.05). There was a significant correlation between ΔKM value and the recovery rate of JOA score. Conclusion Posterior laminoplasty with reattachment of the spinous process can effectively improve the clinical symptoms of OPLL patients,the mechanism may be the K-line shift after decompression at C_2 and T_1.
出处
《脊柱外科杂志》
2018年第1期22-26,共5页
Journal of Spinal Surgery
关键词
颈椎
骨化
后纵韧带
减压术
外科
Cervical vertebrae
Ossification of posterior longitudinal ligament
Decompression
surgical
