中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (4): 726-761.doi: 10.3969/j.issn.1673-8225.2010.04.037

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

一期前后路联合手术治疗多节段颈椎间盘突出合并后纵韧带骨化症

周方宇，李  锋，方  忠，郭风劲，吴  华，陈安民   

  1. 华中科技大学同济医学院附属同济医院骨科，湖北省武汉市 430030
  • 出版日期:2010-01-22 发布日期:2010-01-22
  • 通讯作者: 李 锋，教授，博士生导师，华中科技大学同济医学院附属同济医院骨科，湖北省武汉市 430030 hbwhlf@yahoo.com.cn
  • 作者简介:周方宇☆，男，1980年生，湖北省武汉市人，汉族，华中科技大学同济医学院在读博士，主要从事脊柱与脊髓损伤的实验研究与临床治疗。 victor571@sohu.com
  • 基金资助:

    科技部“十一五”国家支撑计划项目课题“脊髓神经损伤与椎间盘退变防治研究”(2007BAI04B07)资助。

One-stage anterior and posterior operation for multilevel cervical disc herniation accompanying ossification of posterior longitudinal ligament

Zhou Fang-yu, Li Feng, Fang Zhong, Guo Feng-jin, Wu Hua, Chen An-min   

  1. Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
  • Online:2010-01-22 Published:2010-01-22
  • Contact: Li Feng, Professor, Doctoral supervisor, Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China hbwhlf@yahoo.com.cn
  • About author:Zhou Fang-yu☆, Studying for doctorate, Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China victor571@sohu.com
  • Supported by:

    the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period, No. 2007BAI04B07*

PDF

703

被引次数

19

摘要：

背景：多节段颈椎间盘突出合并后纵韧带骨化症会对患者产生严重的脊髓损伤，手术治疗方案目前仍存在争议。采取一期前后路的手术方式治疗能否达到满意效果尚不清楚。
目的：观察采取一期前后路联合手术治疗多节段颈椎间盘突出合并后纵韧带骨化症的临床疗效。
方法：选择武汉同济医院骨科收治的颈椎多节段颈椎间盘突出合并后纵韧带骨化症患者17例，男11例，女6例，年龄42~74岁，平均51.5岁；均采用一期前后路联合手术治疗。术前X射线，CT或MRI检查提示颈椎被多个节段的颈椎间盘突出和骨化的后纵韧带压迫。术后定期复查X射线观察融合率和稳定性及并发症发生情况。
结果与结论：术后伤口均一期愈合情况，全体病例术后随访6~36个月，平均24.5个月。JOA术后6个月评分为(12.88±2.47)分，较术前(6.41±1.28)分明显提高(P < 0.05)。JOA评分改善率为：优5例，良7例，可4例，优良率71%。全体病例植骨在三四个月后均获得融合，颈椎间隙高度及生理曲度恢复满意，未出现内固定断裂、松动及脱出等并发症。提示对于治疗多节段颈椎间盘突出合并后纵韧带骨化症，一期前后路联合手术能早期彻底地减压并重建脊柱的即刻稳定性，是安全有效的手术方式。

关键词: 多节段, 颈椎间盘突出, 后纵韧带骨化症, 前后路, 外科手术

Abstract:

BACKGROUND: Multilevel cervical disc herniation accompanying ossification of posterior longitudinal ligament (OPLL) can seriously hurt the spinal cord. Which way of operative approach is more preferable is still uncertain. Whether one-stage combined anterior and posterior operation can achieve better effects remains unclear.
OBJECTIVE: To explore the therapeutic effect of one-stage anterior and posterior operation for the treatment of multilevel cervical disc herniation accompanying OPLL.
METHODS: Seventeen patients with multilevel cervical disc herniation and OPLL were treated by one-stage anterior and posterior operation at the Department of Orthopaedics, Tongji Hospital, were selected, including 11 males and 6 females, aged 42-74 years, mean aged 51.5 years. X-ray film, CT or MRI before operation showed the cervical cord was compressed by the multilevel herniated cervical discs or the ossified posterior longitudinal ligament. The stability and fusion of the injured segments were observed by regular postoperative X-ray film.
RESULTS AND CONCLUSION: All patients were received a 6-36 months follow-up (24.5 months on average). The postoperative JOA scores were (12.88±2.47) points, which was greater than that of preoperatively [(6.41±1.28) points, P < 0.05]. The improvement-rate of the spinal function after 6 months included 5 excellent cases, 7 good cases, and 4 fair cases. The excellent-good rate was 71%. All the patients got completely reduction, and all grafts got fused at 3-4 months after operation. The cervical intervertebral height and lordosis were satisfied maintained and there was no complication related to internal fixation breakage, loosening or displacement. It suggested that one-stage anterior and posterior operation can provide satisfied decompression earlier and rebuild the spinal stability in time, which is a safe and effective surgical intervention for multilevel cervical spondylotic myelopathy accompanying OPLL.

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