摘要
目的介绍一种无需在椎体两侧开槽游离椎体及后纵韧带骨化物,即可完成颈椎椎体前移并实现脊髓减压的颈椎椎体前移新技术,探讨其初步临床应用价值。方法对2例颈椎后纵韧带骨化合并重度颈椎管狭窄患者,全麻下切除骨化节段椎板、上下邻近关节突关节和前方椎间盘,从前后方完成对骨化节段与上下邻近节段间的松解,再通过前路钛板螺钉提拉或后路钉棒推移实现整个椎体的前移,从而解除骨化后纵韧带对脊髓的压迫。手术分别采用后路+前路术式和前路+后路+前路术式。结果手术过程顺利,未出现动静脉、神经根、脊髓损伤,无脑脊液漏、椎管内血肿等并发症。术后患者四肢麻木乏力症状明显改善,CT及MRI扫描显示颈椎椎体前移位置及距离满意,脊髓减压彻底。结论该颈椎椎体前移术式技术简单,操作安全,是治疗后纵韧带骨化性重度颈椎管狭窄的新手段。
Objective To introduce a new surgical technique of cervical column antedisplacement and fusion(CCAF),which can achieve cervical column antedisplacement and the decompression of spinal cord without slotting on both sides of the vertebral body and making the ossified posterior longitudinal ligament free,and to explore its preliminary clinical application.Methods Under general anesthesia,two patients with ossification of the posterior longitudinal ligament(OPLL)of the cervical spine and severe cervical spinal stenosis were performed laminectomy at the ossified segments,and resection of facet joints adjacent to the upper and lower segments as well as the anterior intervertebral discs.After the anterior and posterior releases between the ossified segments and the adjacent segments,the whole ossified segments were moved forward through the pulling of anterior titanium plate screw,or the pushing of posterior screw rod,so as to relieve the compression of the ossified posterior longitudinal ligament on the spinal cord.The two patients were treated with posteroanterior approach and anterior,posterior and anterior approach respectively.Results The operations were completed smoothly without complications of vascular,nerve root or spinal cord injuries,cerebrospinal fluid leakage,or hematoma in spinal canal.After the operation,the symptoms of numbness and weakness of limbs were improved significantly.CT and MRI scan showed that the position and distance of cervical column antedisplacement were satisfactory,and the decompression of spinal cord was complete.Conclusion CCAF technique is simple and safe,which could be used as a new method for the treatment of OPLL with severe cervical spinal stenosis.
作者
马向阳
陈育岳
黄晓东
张双
倪凌
葛苏
李恒锐
夏虹
MA Xiangyang;CHEN Yuyue;HUANG Xiaodong;ZHANG Shuang;NI Ling;GE Su;LI Hengrui;XIA Hong(Department of Spine Surgery,Hospital of Orthopaedics,General Hospital of Southern Theatre Command,Guangzhou,Guangdong 510010,China)
出处
《中国骨科临床与基础研究杂志》
2019年第5期261-267,共7页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
广州市科技计划项目(201803010046)。
关键词
颈椎
后纵韧带骨化
椎管狭窄
减压术
外科
颈椎椎体前移
椎板切除术
椎间盘切除术
脊柱融合术
Cervical vertebrae
Ossification of posterior longitudinal ligament
Spinal stenosis
Decompression,surgical
Cervical column antedisplacement
Laminectomy
Diskectomy
Spinal fusion
