摘要：

目的: 探讨显微镜下后纵韧带切除在颈椎前路椎间盘切除椎间融合术治疗脊髓型颈椎病中的临床疗效及安全性。方法: 纳入2023年8月至2024年8月在河北医科大学第一医院行显微镜下颈椎前路椎间盘切除椎间融合术且术中全切除后纵韧带的38例脊髓型颈椎病患者，术前和术后3个月采用改良日本骨科协会评分(mJOA)评估脊髓功能，视觉模拟评分(VAS)评估颈部和上肢疼痛情况，颈椎功能障碍指数(NDI)评估颈椎功能障碍程度，并统计术后3个月内手术相关并发症如肢体功能障碍、饮水呛咳、声音嘶哑、咽部疼痛、切口感染等发生情况。结果: 共38例患者均顺利完成手术，手术成功率为100%。与术前相比，术后3个月mJOA评分增加(t=5.225，P=0.000)，VAS评分(Z=-4.029，P=0.000)和NDI指数(Z=-3.915，P=0.000)减少。术后3个月内30例(78.95%)出现短暂性吞咽不适、咽部疼痛、饮水呛咳症状，15例(39.47%)出现声音嘶哑症状，3例(7.89%)出现短暂性左上肢肌力下降，1例(2.63%)出现脑脊液漏，无一例出现切口愈合不良及感染情况。结论: 颈椎退变增生的后纵韧带是脊髓型颈椎病脊髓受压的重要因素之一，显微镜下切除后纵韧带可使病变节段减压更加彻底，明显改善脊髓功能。

关键词: 颈椎病, 纵韧带, 椎间盘切除术, 脊柱融合术

Abstract:

Objective: To investigate the effect and safety of microscopic posterior longitudinal ligament resection during anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy (CSM). Methods: A total of 38 patients with CSM completed resection of posterior longitudinal ligament during ACDF under microscopy were enrolled in The First Hospital of Hebei Medical University from August 2023 to August 2024. The modified Japanese Orthopedic Association Scores (mJOA) was used to assess spinal cord function, Visual Analog Scales (VAS) was used to assess neck and upper limb pain, and Neck Disability Index (NDI) was used to assess the degree of cervical dysfunction before and 3 months after surgery. The operation-related complications within 3 months after surgery such as limb dysfunction, drinking cough, hoarseness, pharyngeal pain and incision infection were counted. Results: All 38 patients experienced successful surgery, with a success rate of 100%. And at 3 months after surgery, there were significant improvements compared to preoperative values: the mJOA score increased (t=5.225, P=0.000), while VAS score (Z=-4.029, P=0.000) and NDI score (Z=-3.915, P=0.000) decreased. There were 30 patients (78.95%) experienced transient symptoms, including dysphagia, pharyngeal pain and drinking cough, 15 patients (39.47%) reported symptoms of hoarseness, 3 patients (7.89%) experienced a transient decrease in muscle strength in the left upper limb, and one patient (2.63%) had cerebrospinal fluid leakage. Notably, no patients exhibited incomplete healing of the incision or infection. Conclusions: The degenerative hyperplasia of the posterior longitudinal ligament of the cervical spine is an important factor of spinal cord compression in CSM. The posterior longitudinal ligament resection under the microscopy can decompress the diseased segment more thoroughly and significantly improve spinal cord function.

Key words: Cervical spondylosis, Longitudinal ligaments, Diskectomy, Spinal fusion