王麒翔　　于洋

[摘要] 目的 比较前后路手术治疗颈椎后纵韧带骨化老年患者的疗效并分析影响手术效果的因素。 方法 本研究将回顾性分析2016年1月至2020年1月在锦州医科大学附属第一医院行手术治疗的老年后纵韧带骨化患者32例，根据术式的不同分为行前路减压融合术的前路组15例;行后路单开门椎管扩大成形术的后路组17例，采用日本骨科协会评分（Japanese orthopaedic association，JOA）及疼痛数字等级评分（Numerical Rating Scale，NRS）来评估手术疗效，比较两组手术时间、术中出血量、住院时间、并发症情况，分析手术疗效的影响因素。 结果 两组患者手术后JOA评分均明显提高（P<0.01）、术后神经改善率无统计学差异（P>0.05）、术后NRS评分降低（P<0.01），前路组术中出血量少于后路组（P<0.05），但后路组的手術时间较前路组的短（P<0.05），两组间住院时间比较差异无统计学意义（P>0.05），术前后路组患者骨化节段数多于前路组（P<0.01），两组的年龄、性别、并发症等方面比较，差异无统计学意义（P>0.05），在两种术式中，男性患者较女性患者术后神经改善率低（P<0.01），术前JOA评分<10分患者较≥10分患者的术后神经改善率低（P<0.01）、术前脊髓高信号患者较无高信号患者术后神经改善率低（P<0.01）。 结论 前路减压融合术与后路单开门椎管扩大成形术对治疗颈椎后纵韧带骨化老年患者均能取得满意效果;患者男性、术前JOA低评分、脊髓高信号是导致手术疗效差的影响因素。

[关键词] 颈椎后纵韧带骨化;前路手术;后路手术;手术疗效

[中图分类号] R445          [文献标识码] B          [文章编号] 1673-9701（2021）14-0084-04

Comparison of the efficacy of anterior and posterior operation in elderly patients with ossification of cervical posterior longitudinal ligament and its influencing factors

WANG Qixiang1   YU Yang2

1.Faculty of Graduate， Jinzhou Medical University， Liaoning， Jinzhou   121000， China; 2.Department of Spinal Surgery， The First Affiliated Hospital of Jinzhou Medical University， Liaoning， Jinzhou   121000， China

[Abstract] Objective To compare the curative effects of anterior and posterior operation for elderly patients with ossification of cervical posterior longitudinal ligament （OPLL）， and to analyze the factors affecting the surgical effect. Methods 32 elderly patients with ossification of OPLL who underwent surgery in the First Affiliated Hospital of Jinzhou Medical University from January 2016 to January 2020 were retrospectively analyzed. According to different surgical methods， they were divided into the anterior group （anterior cervical decompression and fusion， n=15） and the posterior group （open-door laminoplasty through posterior approach， n=17）. Seventeen patients in the posterior group were evaluated by Japanese Orthopaedic Association （JOA） and Numerical Rating Scale （NRS）. The operation time， intraoperative blood loss， hospitalization time and complications were compared between the two groups， and the influencing factors of the operation effect were analyzed. JOA scores of patients in both groups were significantly improved after operation （P<0.01）. There was no significant difference in the postoperative nerve improvement rate（P>0.05）. NRS score decreased after operation（P<0.01）. The amount of bleeding in the anterior group was less than that in the posterior group （P<0.05）， but the operation time of posterior group was shorter than that of anterior group（P<0.05）. There was no significant difference in hospital stay between the two groups（P>0.05）. The number of ossification segments in posterior group was more than that in anterior group before operation（P<0.01）. There was no significant difference in age， gender and complications between the two groups （P>0.05）. Among the two operative methods， the postoperative neurological improvement rate of male patients was lower than that of female patients（P<0.01）. The neurological improvement rate of patients with preoperative JOA score less than 10 points was lower than that of patients with score ≥10（P<0.01）. The neurological improvement rate of patients with high signal intensity of spinal cord before operation was lower than that of patients without high signal intensity after operation（P<0.01）. Conclusion Anterior cervical decompression and fusion and open-door laminoplasty through posterior approach can achieve satisfactory results in the treatment of elderly patients with ossification of CPLL. Male patients， low preoperative JOA score and high signal intensity of spinal cord are the influencing factors leading to poor surgical effects.

[Key words] Ossification of cervical posterior longitudinal ligament; Anterior surgery; posterior surgery; Surgical effect

颈椎后纵韧带骨化（Ossification of posterior longitudinal ligament，OPLL）是一种病因不明，后纵韧带异常改变压迫后方脊髓及神经根导致出现相应症状的疾病，男性多见[1]，主要表现为脊髓型颈椎病的症状，包括出現四肢的肌力下降、皮肤感觉异常、行走时出现踩棉花感。我国上海长征医院通过对7210名退行性颈脊髓病患者的CT观察发现：OPLL的患病率为18.2%，其中男19.73%，女15.65%，好发年龄主要集中70～79岁[2]。对于出现症状且影响日常生活的OPLL患者，手术治疗是十分必要的，前、后路手术是目前临床治疗OPLL的常用术式[3-4]，两者均能取得一定的手术疗效，但是老年OPLL患者往往病情较重，手术耐受差，选择哪种术式仍存在争议。……