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改良型椎板成形术治疗后纵韧带骨化(OPLL)所致颈椎病。

A Modified Laminoplasty Technique to Treat Cervical Myelopathy Secondary to Ossification of the Posterior Longitudinal Ligament (OPLL).

机构信息

Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).

出版信息

Med Sci Monit. 2017 Oct 10;23:4855-4864. doi: 10.12659/msm.902468.

Abstract

BACKGROUND This study aimed to evaluate the validity of modified laminoplasty in treating close-base OPLL with an occupying ratio of more than 60%. MATERIAL AND METHODS Forty-seven close-base OPLL patients with an occupying ratio of more than 60% were treated through modified laminoplasty (N=22) and combined anterior-posterior approach (N=25) in the study, including 17 females and 30 males, with a mean age of 60.59±6.76 years (ranging from 46 to 75 years). The patients' characteristics, the recovery rate of neurological function, length of the operation, intraoperative blood loss, hospital costs, and complications were recorded and compared between the 2 groups. RESULTS The recovery rate of neurological function did not demonstrate a significant difference between the 2 groups (P=0.886). However, length of the operation and intraoperative blood loss in the modified laminoplasty group were shorter than those in the combined anterior-posterior approach group (P=0.001 and P=0.023). Moreover, the mean hospital costs in the modified laminoplasty group (5166.61±123.27 USD) decreased by 33.6% compared with the combined anterior-posterior approach group (7780.12±256.73 USD). Additionally, the complications of the modified laminoplasty group were lower than in the combined anterior-posterior approach group. CONCLUSIONS Modified laminoplasty may be considered a safe and effective strategy for patients that have demonstrated close-base OPLL with an occupying ratio of more than 60% and who cannot endure the trauma caused by the combined anterior-posterior approach due to medical disease.

摘要

背景

本研究旨在评估改良型单开门椎管扩大成形术治疗占据比值大于 60%的紧密基底型后纵韧带骨化症的有效性。

材料和方法

研究纳入了 47 例占据比值大于 60%的紧密基底型后纵韧带骨化症患者,分别采用改良型单开门椎管扩大成形术(N=22)和前后联合入路手术(N=25)进行治疗,其中女性 17 例,男性 30 例,平均年龄 60.59±6.76 岁(46~75 岁)。记录并比较两组患者的一般资料、神经功能恢复率、手术时间、术中出血量、住院费用及并发症。

结果

两组患者的神经功能恢复率差异无统计学意义(P=0.886)。但改良型单开门椎管扩大成形术组的手术时间和术中出血量均短于前后联合入路手术组(P=0.001 和 P=0.023),且改良型单开门椎管扩大成形术组的平均住院费用(5166.61±123.27 美元)较前后联合入路手术组(7780.12±256.73 美元)降低了 33.6%。此外,改良型单开门椎管扩大成形术组的并发症发生率低于前后联合入路手术组。

结论

对于因合并内科疾病而不能耐受前后联合入路手术创伤,且占据比值大于 60%的紧密基底型后纵韧带骨化症患者,改良型单开门椎管扩大成形术可能是一种安全有效的治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce2/5648370/b3ce3eda1b26/medscimonit-23-4855-g001.jpg

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