后路减压内固定手术治疗胸椎黄韧带骨化症的预后影响因素分析

Prognostic factors of posterior decompression and internal fixation for ossification of ligamentum flavum in thoracic spine

目的探讨后路减压内固定手术治疗胸椎黄韧带骨化症(ossification of ligamentum flavum,OLF)的临床疗效,并探讨其预后影响因素。方法自2013-09-2016-09,采用后路减压内固定手术治疗53例胸椎OLF患者,术后随访13-27个月。依据末次随访时的JOA评分改善率,将之分为预后较好组(改善率≥25%)和预后不良组(<25%)。统计所有患者的相关资料,并进行手术预后的组间单因素分析和多因素Logistic回归分析。结果①53例术前JOA评分平均为(5.13±1.06)分,截止末次随访时,已恢复至平均(8.75±1.31)分。其中JOA改善率≥25%者共计42例,均预后较好(79.25%);改善率<25%者共计11例,均预后不良。②单因素分析显示,椎管面积残余率、T2加权像髓内高信号和大小便功能障碍这3项因素的数据,在预后较好组与预后不良组之间存在显著性差异(P<0.05);多因素Logistic回归分析证实,椎管面积残余率<80%、存在T2WI髓内高信号和大小便功能障碍这3项,均为预后不良的独立危险因素之一。结论采用后路减压内固定手术治疗胸椎OLF,可取得较好疗效。但术前椎管面积残余率<80%、存在T2WI髓内高信号和大小便功能障碍者,均是预后不良的危险因素。

Objective To explore the clinical effect of posterior decompression and internal fixation in the treatment of ossification of ligamentum flavum (OLF), and to explore the influencing factors of its prognosis. Methods 53 patients with OLF of thoracic vertebra were treated with posterior decompression and internal fixation in September 2013-September 2016. The follow-up was followed for 13-27 months, with an average of 19.8 months. According to the improvement rate of JOA score at the last follow-up, the patients were divided into better prognosis group (improvement rate≥25%) and poor prognosis group (<25%). The data of all patients were collected, and univariate analysis and multivariate Logistic regression analysis were performed. Results (1) The average preoperative JOA score of 53 patients was (5.13±1.06), and the average rate was(8.75±1.31)at the end of follow-up. Among them, the total improvement rate of JOA was more than 25%(42 cases), and the prognosis was better (79.25%). The total improvement rate of <25% was 11 cases, all of which had poor prognosis.(2) single factor analysis showed that there were significant differences between the 3 factors such as the area residual rate of vertebral canal area, T2 weighted intramedullary high signal and dysfunction of bowel dysfunction (P<0.05), and the multifactor Logistic regression analysis confirmed that the residual rate of spinal canal area was <80%, and the high signal of T2WI intramedullary was present. These 3 items of bowel dysfunction were one of the independent risk factors for poor prognosis. Conclusion Posterior decompression and internal fixation for thoracic OLF is effective. However, preoperative spinal canal residual rate <80%, T2WI high signal and intramedullary dysfunction were all risk factors for poor prognosis.