胸椎黄韧带骨化症的外科治疗及疗效影响因素分析

Surgical treatment of ossification of thoracic ligamentum flavum and analysis of the factors related to outcome

目的探讨胸椎黄韧带骨化症（ossification of ligamentum flavum,OLF）的手术治疗方法及其术后疗效的影响因素。方法回顾性分析2001年5月至2008年9月在我院进行手术治疗的39例胸椎OLF患者,其中30例采用＂揭盖＂式全椎板切除减压,9例采用改良后路全椎板切除减压及短节段椎弓根螺钉内固定治疗。随访术后脊髓功能恢复情况,分析术前病程、术前JOA评分（日本矫形外科学会,11分）、硬化节段、CT分型、脊髓信号改变与术后疗效的关系。结果39例患者均获得随访,随访时间在10个月~8年,平均54个月。根据JOA评分标准进行术前和术后的疗效评价。术后疗效评价为优19例、良14例、可6例,优良率达84.6%。术前病程短,JOA评分高,单节段骨化,CT分型为外侧型及矢状位T2加权像髓内信号无改变的病例术后疗效好。结论＂揭盖＂式全椎板切除减压和改良后路全椎板切除减压是治疗胸椎OLF可靠、有效的手术方式。患者术前病程、术前JOA评分、硬化节段、CT分型及压迫节段MRI示脊髓信号有无改变是影响术后疗效的主要因素。

Objective To investigate the surgical treatment of thoracic ossification of ligamentum flavum（OLF）,and to analyze the factors related to the outcomes. Methods A total of 39 patients with thoracic ossification of ligamentum flavum were treated from May 2001 to September 2008.The posterior en-bloc laminectomy was performed in 30 cases.The modified en-bloc laminectomy and posterior segmental instrumentation were performed in 9 cases.The postoperative results were evaluated with Japanese Orthopedic Association score.The possible factors including disease course,preoperative JOA scores,involved levels,OLF type of CT and intramedullary signal changes on T2-weighted sagittal MRI were analyzed. Results The mean period of follow-up was 54 months.Postoperative outcomes were evaluated based on the JOA scores.Among the 39 patients,19 got an excellent result,14 good and 6 fair.The excellent and good rate was 84.6%.Patients with short disease course,high preoperative JOA scores,single segmental ossification,lateral type of CT,and without intramedullary signal changes on T2-weighted sagittal MRI had good surgical results. Conclusions The posterior en-bloc laminectomy and the modified en-bloc laminectomy with posterior segmental instrumentation are reliable and effective for the treatmemt of thoracic OLF.The disease course,preoperative JOA scores,involved levels,OLF type of CT,and intramedullary signal changes on T2-weighted sagittal MRI are the major factors that influence the outcome.