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1.
Objective To provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament (OPLL) and flaval ligament (OFL). Data sources Published articles about OPLL and OFL were selected using Medline and Embase electronic databases. Study selection An English literature search from January 1980 to December 2006 was conducted. Because many reported cases were incorporated in OFL studies, the key words for search were OFL or OFL and OPLL. The first step revealed 93 studies of which 13 reports of tandem OPLL and OFL (tandem ossification) were selected. Results All studies were case series or case report and advocated that the primary therapy for tandem ossification should be operative. The clinical outcomes of surgery were evaluated in most reports, predominantly using the JOA scores. Gender is the only factor which has prognostic value. A higher proportion of women was found in the failure group A two- stage classification of tandem ossification was developed to relate diagnosis to outcome. Conclusions All patients with suspected ossification of the spinal ligaments should undergo routine MRI screening of the whole spine. The correlation of the classification with surgical treatments needs further studies to validate its usefulness. Chin Med J 2009; 122(2):219-224  相似文献
2.
前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症   总被引:4,自引:0,他引:4  
目的 探讨采用前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症的适应证、方法及其临床效果.方法 2006年4月至2008年3月,25例严重颈椎后纵韧带骨化症患者采用前路多节段椎体次全切除手术进行治疗,年龄42~75岁,平均53.2岁.骨化物分型包括局限型7例,分节型5例,连续型8例,混合型5例;骨化物范围涉及2~4个椎节,平均2.8个椎节;椎管狭窄率50%~97%,平均68.4%.所有患者均通过前路椎体次全切除术,切除骨化后纵韧带减压,并采用钛网植骨钢板固定重建颈椎稳定性.结果 本组两椎体次全切除16例,三椎体次全切除9例.随访2~18个月,患者神经功能JOA评分从术前平均9.3(5~12)分提高至术后平均14.2(11~16)分,恢复率22.2%~87.5%,平均63.2%.并发症包括6例脑脊液漏(4例间歇性脑脊液假性囊肿),2例神经根麻痹,1例血肿压迫,1例术后短期四肢肌力下降.结论 前路多椎体次全切除治疗严重颈椎后纵韧带骨化症有助于提高此类患者的手术疗效,但手术难度大,风险高.  相似文献
3.
Background Ossification of the posterior longitudinal ligament (OPLL) is characterized by the replacement of ligamentous tissue with new ectopic bone formation, and has a strong genetic background. Because of the abnormal bone metabolic features and the strong genetic component, osteoporosis is a related disorder with OPLL. Three polymorphisms on chromosome 20p12 were identified associated with the risk of osteoporosis and osteoporotic fracture.The rs996544 (C/T) "TT" and rs965291 (G/A) "AA" genotypes conferred higher risks for vertebral and hip fractures. The osteoporosis haplotype is defined by two polymorphisms, rs1116867 (A) and D35548 (T). However, it remains unknown whether these three polymorphisms predispose to an increased frequency and severity of OPLL in Han Chinese patients.Methods A total of 420 OPLL patients and 506 age- and sex-matched controls were studied. Three single nucleotide polymorphisms (SNPs), rs996544 (C/T), rs965291 (G/A) and rs1116867 (A/G), were analyzed by direct sequencing.Associations between these SNPs with the occurrence and extent of OPLL were statistically evaluated.Results There was no significant association between the rs996544 (C/T) polymorphism and the prevalence of OPLL.The rs1116867 (A/G) polymorphism "AG" genotype was associated with the occurrence of OPLL. The rs1116867 (A/G) polymorphism "G" allele was associated with the occurrence of OPLL, but not with the extent of OPLL. The rs965291 (G/A) polymorphism in female patients was statistically different between cases and controls (P 〈0.05). The rs965291 (G/A) polymorphism "A" allele was associated with the occurrence of OPLL in female patients. For the rs965291 (G/A)polymorphism, patients with the "A" allele (genotype, "AG" or "AA") showed a significantly greater number of ossified cervical vertebrae than those without the "A" allele (genotype, "GG", P 〈0.05), particularly in female patients.Conclusions The rs1116867 (A/G) and rs965291 (G/A) polymorphisms on chromosome 20p12 are associated with the occurrence and the extent of OPLL, at least in Han Chinese subjects. Our data should advance our understanding of the molecular etiology of OPLL and may guide approaches to prevent the onset of OPLL.  相似文献
4.
Background Ossification of the posterior longitudinal ligament (OPLL) has a strong genetic background. Previous studies have shown that bone morphogenetic protein-2 (BMP2) and BMP2 mRNA are expressed in ossifying matrix and chondrocytes adjacent to cartilaginous areas of OPLL tissues and mesenchymal cells with fibroblastic features in the immediate vicinity of the cartilaginous areas. It is suggested that BMP2 plays different roles in the different stages of development of OPLL. However, it remains unknown which factors induce ligament cells to produce BMP2. Methods OPLL patients (n=-192) and non-OPLL controls (n=304) were studied. Radiographs of the cervical spine were analyzed for extent of OPLL. We investigated whether single nucleotide polymorphisms of exons 3(-726) T/C and 3(-583) NG in the BMP2 gene are statistically associated with genetic susceptibility to OPLL in Chinese Han subjects. Results There was no statistical difference between the occurrence of exons 3(-726) T/C and 3(-583) NG and the occurrence of OPLL in the cervical spine. However, there was a significant association between occurrence of exon 3(-726) T/C polymorphism and occurrence of OPLL in males of cases and controls in the cervical spine. In addition, no significant association was found between the exons 3(-726) T/C and 3(-583) A/G with number of ossified cervical vertebrae in OPLL patients. Conclusions Exon 3(-583) A/G polymorphism in BMP2 gene is not associated with the occurrence and the extent of OPLL in the cervical spine. Chinese Han male patients with TC and CC genotypes in exon 3(-726) T/C have genetic susceptibility to OPLL but not to more extensive OPLL in the cervical spine.  相似文献
5.
手术刺激对腰椎后纵韧带内BMP-2及BMP-7 mRNA表达的影响   总被引:1,自引:0,他引:1  
目的 通过手术建立动物模型,增加后纵韧带的张力,检测韧带中BMP-2及BMP-7的表达及水平.探讨机械应力刺激对后纵韧带骨化发生及发展的作用机制.方法 成年健康的新西兰大白兔80只,随机分为4组.手术方式:①腰椎后路全椎板切除组(全椎板组);②腰椎后路全椎板切除加肌肉切断组(全椎板加肌肉组);③单纯椎旁肌止点切断组(肌肉组);④对照组,不作任何处理.分别于术后2、4及8周.取实验动物手术节段后纵韧带标本,RF-PCR方法检测BMP-2及BMP-7 mRNA的表达水平.结果 ①全椎板切除加肌肉切断组的BMP-2及BMP-7水平上升最明显,与对照组相比差异有显著性;②全椎板切除组和单纯椎旁肌止点切断组的BMP-2及BMP-7水平上升,与对照组比较差异有显著性.结论 BMP-2在后纵韧带骨化的早期始动阶段发挥起动因子的作用,而BMP-7参与后纵韧带骨化的全过程.  相似文献
6.
对1582份 41岁以上的门诊病人的颈椎侧位×线片中发现后纵韧带骨化27例,患病率为1.7%。男性约为女性2倍。后纵韧带骨化的患病率有随年龄的增长而上升的趋势。27例后纵韧带骨化在侧位×片上分为4型:连续型7例,节段型13例,混合型2例,局限型5例。  相似文献
7.
对C_4水平以下节段性颈椎后纵韧带骨化(OPLL)33例行前路骨化韧带切除术。29例随访1~10a,按JOA标准评定疗效。结果:优(术后改善率80%以上)13例;良(50%~79%)10例;改进(5%~49%)3例;无变化(5%以下)2例;加重1例,有效率89.6%。提示:C_4以下节段性OPLL适合前路开槽切除;C_4以上的节段性OPLL或连续型OPLL适合后路椎板成形椎管扩大术。充分暴露骨化灶的范围,才能将其完整切除。  相似文献
8.
目的:对颈椎后纵韧带骨化症(OPLL)的前路减压融合手术效果进行分析。方法:对28例颈椎OPLL患者进行了颈椎前路手术治疗,其中切除1个椎节8例(I组),2个椎节11例(Ⅱ组)。3个椎节9例(Ⅲ组),术后采用日本矫形外科学会(JOA)评定标准进行评判,结果:平均随访时间2.3年,平均改善率75.8%,患病时间,术前脊髓损伤及症状的轻重均影响到神经功能恢复。结论;对于3个节段以下的节段性OPLL适合  相似文献
9.
目的:研究不同手术方式对颈椎后纵韧带骨化症(OPLL)的治疗效果和远期影响。方法本组76例患者均行手术治疗,其中颈前路减压+植骨融合术18例,颈后路半椎板减压43例,全椎板减压4例,椎管成形术11例(单开门5例,双开门5例)。结果:手术减压治疗效果的优良率为79.7%,但不同术式对远期效果的影响不同,部分患者出现后颈椎失稳,其中全椎板减压术的发生率为50%,半椎板减压术为22.2%,颈前路术压+植  相似文献
10.
目的:探讨后纵韧带切除在颈前路减压中的临床意义.方法:回顾性分析1997年3月至2002年12月间经颈前路手术治疗的脊髓型颈椎病患者共116例,分为后纵韧带切除组(n=62)和后纵韧带保留组(n=54),按照日本骨科协会(JOA)评分系统进行临床疗效评价,利用MRI技术测量脊髓矢状径并进行比较.结果:平均18个月的随访结果表明,后纵韧带切除组神经功能恢复率为(74±23)%,显著高于后纵韧带保留组[(63±21)%,P<0.01];后纵韧带切除组术后脊髓矢状径增加值为(3.78±1.25) mm,显著高于后纵韧带保留组[(2.02±1.03) mm,P<0.01].结论:颈椎前路切骨减压后行后纵韧带切除使病变节段减压更加彻底,有利于脊髓型颈椎病患者的脊髓形态及神经功能恢复.  相似文献
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