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确定无固定的颈椎前路椎体次全切除融合术治疗后纵韧带骨化症的手术疗效。

To Determine the Surgical Outcome of Anterior Cervical Corpectomy and Fusion without Fixation for Ossification of Posterior Longitudinal Ligament.

作者信息

Younus Syed Muneeb, Imran Muhammad, Khan Ateeq Ahmed, Basar Saqib, Sheikh Daniya

机构信息

Department of Neurosurgery, Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan.

出版信息

Asian J Neurosurg. 2019 Jul-Sep;14(3):780-784. doi: 10.4103/ajns.AJNS_54_17.

Abstract

AIMS

The purpose of our study is to evaluate the surgical outcome in patients undergoing anterior cervical corpectomy without fixation with plates and screws for the treatment of ossification of posterior longitudinal ligament (OPLL).

SUBJECTS AND METHODS

The type of study was case series and was conducted from January 2015 to December 2015 for 1-year duration at the Department of Neurosurgery at a Tertiary Care hospital in Karachi, Pakistan. A total of = 20 patients (16 men and 4 women; mean age of 57.45 ± 6.4 years [range: 45-68 years]) were included after thorough clinical history and physical examination. Neurological evaluation was done using the Japanese Orthopedic Association (JOA) scoring system. The pre- and post-operative JOA scores were used to calculate recovery rate (RR) of the patients. Radiographic assessment was done using various modalities such as X-ray, computed tomography scan, and magnetic resonance imaging. Surgical outcome and complications were studied and the data were analyzed using SPSS 21.

RESULTS

After the uniform follow-up period of 12 months, mean JOA scores improved from 9.1 ± 1.37 preoperatively to 14.3 ± 1.69 postoperatively and mean RR was 67.01 ± 15.5%. All the patients showed successful osseous fusion while one patient did not. Two patients developed cerebrospinal fluid leakage, one patient developed recurrent laryngeal nerve palsy, and one expired due to iatrogenic neurological deterioration.

CONCLUSION

Anterior cervical corpectomy without fixation with plates and screws is an effective surgical procedure for the treatment of OPLL (for up to three cervical levels of OPLL). It gives good neurological recovery with fewer postoperative complications.

摘要

目的

本研究旨在评估接受前路颈椎椎体次全切除且未使用钢板和螺钉固定治疗后纵韧带骨化症(OPLL)患者的手术效果。

对象与方法

本研究为病例系列研究,于2015年1月至2015年12月在巴基斯坦卡拉奇一家三级护理医院的神经外科进行,为期1年。经过全面的临床病史和体格检查后,共纳入20例患者(16例男性和4例女性;平均年龄57.45±6.4岁[范围:45 - 68岁])。使用日本骨科协会(JOA)评分系统进行神经功能评估。术前和术后的JOA评分用于计算患者的恢复率(RR)。使用X线、计算机断层扫描和磁共振成像等多种方式进行影像学评估。研究手术效果和并发症,并使用SPSS 21对数据进行分析。

结果

经过统一的12个月随访期后,平均JOA评分从术前的9.1±1.37提高到术后的14.3±1.69,平均RR为67.01±15.5%。所有患者均实现了成功的骨融合,但有1例患者未实现。2例患者发生脑脊液漏,1例患者出现喉返神经麻痹,1例患者因医源性神经功能恶化死亡。

结论

前路颈椎椎体次全切除且不使用钢板和螺钉固定是治疗OPLL(OPLL累及颈椎节段不超过三个)的一种有效手术方法。它能带来良好的神经功能恢复,且术后并发症较少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/64f1/6703063/b1fdfe2ba6b9/AJNS-14-780-g001.jpg

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