颈椎曲度对颈椎后路椎管扩大椎板成形术治疗颈椎后纵韧带骨化症临床疗效的影响

关键词：颈椎  骨化，后纵韧带  减压术，外科

Keywords:Cervical vertebrae  Ossification,posterior longitudinal ligament  Decompression,surgical

摘要：

      目的 探讨颈椎曲度对颈椎后路椎管扩大椎板成形术治疗颈椎后纵韧带骨化症（OPLL）临床疗效的影响。方法 2021年1月—2023年1月，采用颈椎后路椎管扩大椎板成形术治疗颈椎OPLL患者113例，根据术前颈椎曲度将患者分为前凸组（n=58）和后凸组（n=55）。手术前后采用视觉模拟量表（VAS）评分评价颈部疼痛程度，采用颈椎功能障碍指数（NDI）评价颈椎功能，采用日本骨科学会（JOA）评分评价神经功能状况。结果 所有手术顺利完成，所有患者随访（36.2±11.6）个月。2组术后12个月及末次随访时的VAS 评分、NDI及JOA评分较术前明显改善，差异均有统计学意义（P < 0.05）；组间相比，术后12个月及末次随访时的VAS评分、NDI及JOA评分差异均无统计学意义（P > 0.05）。亚组分析发现，2组的K线（+）和K线（-）亚组的术后12个月及末次随访时的VAS评分、NDI及JOA评分差异均无统计学意义（P > 0.05）。结论 对于颈椎OPLL患者，无论颈椎曲度是前凸还是后凸，K线（+）还是K线（-），采用颈椎后路椎管扩大椎板成形术治疗均能获得满意的临床疗效。

Abstract:

      Objective To investigate the effect of cervical curvature on the clinical efficacy of posterior cervical laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament（OPLL）. Methods From January 2021 to January 2023，113 patients with cervical OPLL were treated with posterior cervical laminoplasty. The patients were divided into lordotic group（n=58） and kyphotic group（n=55） based on preoperative cervical curvature. At pre- and post-operation，the neck pain intensity was evaluated using the visual analog scale（VAS） score，cervical spine function was evaluated using the neck disability index（NDI），and neurological function was evaluated using the Japanese Orthopaedic Association（JOA） score. Results All the operations were successfully completed，and all the patients were followed up for（36.2±11.6） months. The VAS scores，NDI and JOA scores at postoperative 12 months and the final follow-up were significantly improved in both groups compared to preoperative levels，and the differences were statistically significant（P < 0.05）；there was no statistically significant difference in VAS scores，NDI and JOA scores between groups at postoperative 12 months and the final follow-up（P > 0.05）. Subgroup analysis found that there was no statistically significant difference in VAS scores，NDI and JOA scores between the K-line（+） and K-line（-） subgroups of the 2 groups. Conclusion For patients with cervical OPLL，regardless of whether the cervical curvature is lordosis or kyphosis，K-line（+） or K-line（-），satisfactory clinical efficacy can be achieved through posterior cervical laminoplasty.