胸椎黄韧带骨化症的手术疗效及影响因素分析

Surgical curative effect and influencing factors of ossification of ligamentum flavum

目的探讨胸椎黄韧带骨化症的手术疗效及相关影响因素。方法以手术治疗的96例胸椎黄韧带骨化症患者为研究对象,记录治疗前(T0)、术后6个月(T1)、术后12个月(T2)、术后24个月(T3)的下腰痛评分及改善率。根据疗效评估结果将受试者分成优、良组(A组)和可、差组(B组),比较两组年龄、性别、体质指数、病程、术前JOA评分、影像学分型、手术节段、椎管面积残余率、合并其他脊柱病变症状、术前MRI T2相脊髓内高信号情况等的差异。对单因素分析后有统计学意义的指标行非条件Logistic回归分析。结果 1 96例经24个月随访,疗效评估结果显示:74例为A组,优44例(45.8%)、良30例(31.3%);22例为B组,可17例(17.7%)、差5例(5.2%)。所有受试者T3时JOA评分较T0时显著提高(P<0.05)。2两组患者的性别、体质指数、影像学分型、合并其他脊柱病变症状及术前MRI T2相脊髓内高信号情况等资料比较差异均无统计学意义(P>0.05)。A组年龄<60岁者52例(70.3%),病程<24个月者53例(71.6%),中上胸节段者50例(67.6%),椎管面积残余率≥50%者48(64.9%),术前JOA评分为(7.0±1.5)分,各项依次高于B组的9例(40.9%)、8例(36.4%)、9例(40.9%)、8例(36.4%)、(5.1±1.0)分,差异均有统计学意义(P<0.05)。3年龄≥60岁、病程≥24个月、手术节段累及胸腰段、椎管面积残余率<50%及术前JOA评分<6分均为影响胸椎黄韧带骨化症患者手术效果的独立危险因素(P<0.05)。结论年龄、病程、手术节段、椎管面积残余率、术前JOA评分均为影响胸椎黄韧带骨化症患者手术治疗效果的重要因素,需引起临床重视。

Objective To investigate the surgical curative effect and related influencing factors of ossification of liga -mentum flavum .Methods Ninety-six cases of patients with ossification of ligamentum flavum treated by surgery were selected .The low back pain scores and the improvement rates before treatment （ T0 ） , 6 months after surgery （ T1 ） , 12 months after surgery （ T2 ） and 24 months after surgery （ T3 ） were recorded .According to the evaluation results of curative effects , the subjects were divided into excellent and good group （ group A ） , and fair and poor group （group B）.Age, gender, body mass index, duration of disease, preoperative JOA score, imaging type, surgi-cal segment , residual rate of spinal canal areas , combined with symptoms of other spinal lesions and preoperative MRI T2 phase high signal in spinal cord were compared between the two groups .Non-conditional Logistic regression analy-sis was performed in indexes with significant differences after univariate analysis .Results ① Ninety-six patients were followed up for 24 months, a total of 74 cases of patients as group A , curative effect evaluation results were ex-cellent in 44 cases （45.8%）, good in 30 cases （31.3%）.There were a total of 22 patients in group B, and the ef-ficacy was fair in 17 cases （17.7%） and poor in 5 cases （5.2%）.JOA scores of all subjects at T3 were significantly higher than those at T 0 （ P〈0.05 ）; ② There was no significant difference in gender , body mass index , imaging type, combined with other symptoms of spinal lesions , preoperative MRI T2 phase high signal in spinal cord and other data between the two groups （P〉0.05）.In group A, there were 52 cases （70.3%） 〈60 years old, 53 cases （71.6%） whose duration of disease 〈24 months, 50 cases （67.6%） with upper thoracic segment and 48 cases （64.9%） with residual rate of spinal canal areas ≥50%, and the preoperative JOA score was （7.0 ±1.5） points, which was higher than those in group B [ 9 cases （ 40.9%） , 8 cases （ 36.4%） , 9 cases （ 40.9%） , 8 cases （36.4%）, （5.1 ±1.0） points] （P〈0.05）.③Age over 60 years old, course of disease longer than 24 months, surgical segment involving the thoracolumbar segment , residual rate of spinal canal areas less than 50%and preopera-tive JOA score less than 6 points were independent risk factors influencing the surgical curative effects in patients with ossification of ligamentum flavum （P〈0.05）.Conclusions Age, course of disease, surgical segment, residual rate of spinal canal areas , preoperative JOA score are important factors influencing the surgical curative effect in pa -tients with ossification of ligamentum flavum , which needs clinical attention .