胸椎黄韧带骨化的MRI分型对胸椎管狭窄手术方法选择的影响

Influence of MRI classification of ligamentum flavum ossification to the surgical choices treating thoracic canal stenosis

目的探讨胸椎黄韧带骨化的MRI分型对胸椎管狭窄手术方法选择的影响。方法1991年6月至2006年2月，黄韧带骨化性胸椎管狭窄患者34例，男23例，女11例；年龄33-72岁，平均52．6岁。均经CT确诊，并按MRI特征分型，选择不同手术方法。孤立型5例，选择椎管后壁切除减压法；连续型20例，选择全椎板整块漂浮法减压；跳跃型或合并其他部位压迫型7例，全椎板整块漂浮法一期或分期减压；复合型2例，次环状减压法。记录手术前、后6、12、24、36个月JOA评分。采用Epstein标准评价手术效果。对不同时期JOA评分进行统计学分析。结果30例患者术后获得36个月的随访。JOA评分比较，术后不同时期均与术前有显著差异（尸〈0．05）；术后不同时期两两比较，6个月与12个月、12个月与24个月、24个月与36个月比较，差异均无统计学意义（P〉0．05）；但术后6个月与24个月比较，差异有统计学意义（P＜0．05）。按Epstein标准评价，术后36个月时30例患者：优18，良5例，改善6例，差1例；优良率为76．7％。结论正确分辨胸椎黄韧带骨化的MRI特征有利于确定胸椎管狭窄的具体手术范围及术式。

Objective To investigate the influence of MRI classification for ossification of ligamenturn flavum （OLF） to the surgical choice to treat thoracic canal stenosis. Methods Thirty-four OLF with thoracic canal stenosis patients were conducted from June 1991 to February 2006, including 23 males and 11 females, with an average age of 52.6 years （range, 33-72 years）. Diagnosis was made by CT scan, MRI, and subsequent histology. According to the characteristics of MRI, localized （5/34 patients） type were treated with removing posterior wall of thoracic canal; continued （20/34 patients） with en bloc laminectomy using ＂ lamina floating＂ technique; skip and combined with another compression （7/34 patients）, decompression one stage or stages with en bloc laminectomy using ＂lamina floating＂ technique; compound type （2/34 patients） combining with cervical and/or lumbar stenosis, decompressing with part-circle decompression. According to JOA score system, evaluating and recording the results of preoperative, postoperative 6, 12, 24, 36 months, respectively. Results Thirty patients were followed up for 36 months. According to JOA score, there was siguifieant difference between preoperative and different stages postoperatively （P〈 0.05）; Compared between different stages after surgery, there was statistical significance between 6 months and 24 months （P〈 0.05）, while the others were negative （P 〉0.05）. Moreover, by the end of 36 months after surgery, there were 18 patients with excellent results, 5 with good, 6 with improvent, and 1 with poor. According to Epstein criteria, while the percentage of excellent or good was 76.7%. Conclusion The appropriate distinguish of MRI classification to OLF is helpful to accurately confirm the extent and surgical method of thoracic canal stenosis.