经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症讲义.doc

经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症 王振宇 孙元 王强 大连市友谊医院骨科 辽宁大连 116100 大连市友谊医院手术室 辽宁大连 116100 【摘要】 目的 研究经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament，OPLL）的疗效。 方法 自2006年8月至2011年8月，采用经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症27例，其中男19例，女8例，年龄48~82岁，平均63.6岁。手术前后用日本矫形外科学会（JOA）评分判断神经功能：用疼痛视觉模拟评分（VAS）评价颈肩痛程度。 结果 所有患者均获随访，随访时间为3个月~5年，平均18个月。术后JOA评分为13.3（10~17）分，较术前10.2（5~14）分有显著改善（t=14.72，p0.01）。术后症状优良率88.9%。仅2例出现C5神经根麻痹，为一过性。术后颈肩痛VAS评分平均为1.9（1~3）分，较术前5.2（4~6）分明显缓解（t=14.25，p0.01）。 结论 经后路椎管扩大减压术能使脊髓彻底减压，充分后移，避免C5神经根麻痹，是目前治疗该病的较好方法。 【关键词】颈椎；后纵韧带、骨化；减压术，外科 Posterior cervical enlarged laminectomy for multisegmental ossification of the posterior longitudinal ligament WANG Zhen-yu, SUN Yuan, WANG Qiang. Department of orthopaedics, Dalian Friendship Hospital, Dalian 116100, China. 【Abstract】Objective To study the results of posterior cervical enlarged laminectomy for multisegmental ossification of the posterior longitudinal ligament. Methods Totally 27 patients with multisegmengtal cervical OPLL were treated by posterior cervical enlarged laminectomy from august 2006 to august 2011.There were 19 males and 8 females,with an average age of 63.6 years (ranged,48-82 years).JOA scoring system and the visual analogue scale (VAS) scoring were applied to evaluate the neurological function and neck/shoulder pain respectively. Results All cases were followed up for 3 months to 5 years(average 18 months).JOA score has improved from 10.2(5-14) preoperatively to 13.3(10-17) postoperatively(t=14.72，p0.01).The excellent and good rate was 88.9%.The palsy of C5 nerve root occurred in only 2 patients,both recovered after surgery.The mean postoperative VAS score was 1.9(1-3),comparing with the preoperative score 5.2(4-6).The pain in neck/shoulder was alleviated obviously (t=14.25，p0.01). Conclusion Posterior cervical enlarged laminectomy is an effective method in treating multisegmental cervical OPLL,in terms of significant poseterior shift fo the spinal cord,relief of cervical/s