合并腰椎疾患的下胸椎黄韧带骨化临床诊治

目的探讨合并腰椎疾患的下胸椎黄韧带骨化临床特点及诊治方法。方法下胸椎黄韧带骨化同时存在腰椎疾患的患者23例,诊断结合X线、椎管造影、CT、MRI检查,体征以肌张力增高和深反射异常为特点;患者均采用病变节段全椎板减压手术治疗。结果23例均获随访,时间10-36个月,手术减压1-3节胸椎椎板,患者在末次随访时都有不同程度的神经功能改善。术后功能恢复优4例,良13例,可6例。术后到末次随访时无一例患者因腰椎疾病而再次接受手术。结论合并腰椎疾患的下胸椎黄韧带骨化需要注意将客观体征与多种影像学检查相结合,尽早诊断、早期手术。

Thoracic ossification of ligamentum flavum accompanied by lumbar degenerative diseases: diagnosis and treatment

Objective To study the characteristics of diagnosis and treatment to thoracic ossification of ligamentum flavum accompanied by lumbar degenerative diseases.Methods The data of 23 cases with thoracic ossification of ligamentum flavum lumbar degenerative diseases,which included roentgenograph,myelography,CT,MRI,and physical examination of hypermyotonia and abnormality of the deep reflexes.All the patients were treated by the posterior decompression with preoperative and postoperative nerve function measured by JOA scores.Results All cases were followed up for 10~36 months.The operations were done with a range of 1~3 thoracic laminae decompressed.Postoperative nerve function was improved at last follow-up with different extents.The functional results were excellent in 4 cases,good in 13,and fair in 6.No revision was needed for lumbar lesion.Conclusions Thoracic ossification of ligamentum flavum accompanied by lumbar degenerative diseases suggested that surgeon should pay more attention to the physical signs.Multiple ossification of ligamentum flavum accompanied by lumbar degenerative diseases should be cautious of objective signs and adjunctive examination and should be treated as early.