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前后路减压融合术治疗颈椎后纵韧带骨化症的效果
作者:王贵江  申沧海  崔涛  杨健  孙立山  彭宁宁  杨成  王力国 
单位:沧州市中心医院 骨四科, 河北 沧州 061001
关键词:脊椎后纵韧带 骨化症 前入路减压 后入路减压 
分类号:R681.5+5
出版年·卷·期(页码):2020·39·第二期(188-194)
摘要:

目的: 探究前后路减压融合术治疗复杂颈椎后纵韧带骨化的临床效果。方法: 选取2015年3月至2017年5月间在我院诊断并治疗的颈椎后纵韧带骨化症的患者86例,以手术入路方式不同分为前路减压融合术(ADF)组及后路减压融合术(PDF)组,每组43例,统计并对比两组手术时长、术中出血及住院时间;对比患者治疗前后疼痛程度(视觉模拟评分,VAS)及治疗前后颈椎功能(日本骨科学会评分,JOA);记录比较各组治疗相关并发症发生情况,同时对比治疗前后脊髓压迫情况,包括:椎管狭窄率、椎管面积及脊髓/椎管比。结果: ADF组的手术时长显著高于PDF组(t=2.641,P=0.010),ADF组的术中出血量显著小于PDF组(t=-37.961,P=0.000);术后两组VAS评分均显著下降(P<0.05),其中ADF组在术后15 d及术后30 d的VAS评分显著小于PDF组(t=-2.853,-9.693;P=0.005,0.000);两组患者治疗后30 d和1年的JOA评分均较术前均显著提高(P<0.05),ADF组的脊柱后凸患者改善率显著高于PDF组(t=2.175;P=0.032);ADF组的治疗相关并发症发生率显著高于PDF组(37.21% vs 9.30%;χ2=6.279,P=0.012);术后1年两组的椎管狭窄率及脊髓/椎管比较治疗前显著下降(P<0.05),椎管面积较治疗前显著提高(P<0.05),两组上述指标治疗前后差值无明显差异(P>0.05)。结论: 前入路减压及后入路减压均具有较好的治疗颈椎后纵韧带骨化症的疗效,前入路方式在术中出血、疼痛改善及脊柱后凸的治疗方面具有优势,后入路方式在手术时长、治疗并发症方面具有优势,两者远期治疗情况相似。

Objective: To explore the effect of anterior and posterior decompression fusion in treatment of OPLL. Methods: 84 patients with ossification of posterior longitudinal ligament in our hospital from March 2015 to May 2017 were divided into ADF group (43 cases) and PDF group (43 cases) according to the operation. The operative time, intraoperative bleeding and hospital stays of each group were compared, the VAS score and JOA score before and after treatment were compared, the incidence of therapeutic complications and compression including spinal stenosis rate, canal area and spinal cord-to-spinal canal ratio were also compared. Results: The operative longer time(t=2.641,P=0. 010)and less intraoperative bleeding(t=-37.961,P=0.000) in the ADF were observed compared with the PDF group. Both VAS score were significantly reduced after treatment(P<0.05), the score of the ADF group on postoperative d 15 and d 30 was significantly lower than that of the PDF(t=-2.853,-9.693;P=0.005,0.000), Both JOA scores were significantly increased after treatment(P<0.05),the improvement rate of kyphotic patients in the ADF group was significantly higher than that of the PDF group(t=2.175;P=0.032), the incidence of treatment-related complications in the ADF group was significantly higher than that of the PDF group(37.21% vs 9.30%; χ2=6.279,P=0.012). The spinal stenosis rate and spinal cord-to-spinal canal ratio of both groups in postoperative 1 year were significantly decreased while the canal area were significantly increased(P<0.05), there was no significant difference on the above indicators between the two groups before and after treatment(P>0.05). Conclusions: Both ADF and PDF have equal good effect on the treatment of OPLL, ADF has advantages in less intraoperative bleeding volume, better pain improvement and kyphosis treatment, while PDF has advantages in operation time and treatment complications, the long-term effects of the two groups are similar.

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