胸椎连续性多节段黄韧带骨化症的外科治疗

Surgical treatment of contiguous multiple-level ossification of ligament flavum causing thoracic cord compression

目的:探讨胸椎连续性多节段黄韧带骨化症致胸脊髓压迫患者的流行病学、临床表现、影像学表现及手术效果。方法:对18例胸椎连续性多节段黄韧带骨化症致胸脊髓压迫患者的临床及影像学资料进行回顾性研究。患者平均年龄57岁(43～72岁),病程平均7.5月(2 d～16月)。16例患者行椎板切除术,2例行椎管成形术,平均随访34个月(28～49个月)。术前及术后应用JOA评分标准进行疗效评价。结果:患者术前JOA平均得分为3.6分(0～6),终末随访JOA平均得分8.3分(5～11),术后平均恢复率为66.3%(33.3%～100%)。结论:胸椎连续性多节段黄韧带骨化症致脊髓压迫应尽早治疗;MRI和CT扫描能明确压迫部位及程度;采用后路胸椎板切除或椎管成形术均获得良好的效果。

Objective： To discuss the epidemiology, clinical presentation, radiology （CT＆MRI） and surgical treatment in these patients with myelopathy caused by contiguous multilevel ossification of ligament flavum. Methods： Medical notes and imaging of the eighteen Chinese patients with myelopathy caused by contiguous multilevel ossification of ligament flavum were reviewed. The mean age was 57 years （range 43-72 years）. The mean course of disease was 7.5 months （range 2 days-16 months）. Sixteen patients were treated by laminectomy and two by laminoplasty. The average follow-up duration was 34 months （range 28-49 months）. The outcome was evaluated by Japanese Orthopaedics Association （JOA） Score. Results： Mean JOA score of preoperation was 3.6 （range 0-6）, mean final JOA score of 8.3, mean percentage of recovery after surgery in terms of JOA score was 66.3% （33.3%-100%）. Conclusion： Contiguous multilevel ossification of ligament flavum should be treated as early as possible. Magnetic resonance imaging and even CT scan examinations may define the presence of thoracic ossification of ligament flavum. Posterior decompression, especially with en bloc dissection of laminae, gives satisfactory results.