手术治疗胸椎黄韧带骨化症的疗效及其影响因素

The surgical outcome of thoracic myelopathy due to ossification of the ligamentum flavum

目的:探讨胸椎黄韧带骨化症手术治疗的疗效及其影响因素。方法:回顾性总结1986年1月至2003年4月我院采用“揭盖式”胸椎管后壁切除术治疗的135例胸椎黄韧带骨化症患者的资料,随访术后脊髓功能恢复情况,分析患者年龄、术前病程、手术节段与部位、影像学分型及JOA评分等与疗效的关系。结果:135例中82例获得随访,随访率60.7%,平均随访时间5年6个月(2～14年),术后优良率74.4%,有效率92.7%;68.4%的患者在术后2年内恢复停滞,26.3%的患者主诉术后2￣5年仍有缓慢恢复;患者的术前病程、年龄、手术节段对术后疗效有显著影响(P<0.05);手术节段累及胸腰段者术后疗效较局限于中上胸椎者差。结论:“揭盖式”椎管后壁切除术是治疗胸椎黄韧带骨化症可靠、有效的手术方式。患者术前病程、年龄及手术部位是影响手术疗效的主要因素。

Objective：To investigate the surgical outcome and influence factors of thoracic myelopathy caused by ossification of the ligamentum flavum（OLF）. Method：All of the 135 patients with thoracic myelopathy induced by OLF treated with en-bloc removal of the spinal canal＇s posterior wall termed as the ＂cap uncovering＂ technique from January of 1986 to April of 2004 were studied retrospectively,and the post-operation resuits were observed.The possible influence factors including age at operation,pre-operation duration,decompression site,OLF types,JOA score and so on were analyzed.Result：82 of 135 were followed up for an average period of 66 months（24-168 months）,and the percentage of follow-up was 60.7%. The functional results were excellent or good in 74.4%,with the tatal satisfactory rate of 92.7%.The recovery process of 68.4% patients ceased 2 years after operation,while 26.3% patients continued in 2-5 years after operation.Statistics showed that the pre-operation duration,the age at operation and the decompression site was factors influencing the long-term outcome remarkably （P〈0.05）.The outcome of cases whose decompression site limited in T10-L2 vertebrae was worse than those in T2-T9.Conclusion：Removal of the posterior wall of the spinal canal via the ＂cap uncovering＂ technique is a reliable and effective treatment for thoracic OLF.The pre-operation duration,the age at operation and the decompression site are major factors influencing the outcome.