颈椎后纵韧带骨化症的三维椎管占比对前路手术预后的评估

[目的]探讨颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)前路手术患者的骨化物椎管容积占比(3D)对预后的评估。[方法]回顾性分析2012年1月~2015年12月本院收治的39例颈椎OPLL行前路手术患者。术前、术后2个月、术后半年及末次随访均进行颈椎JOA评分(Japanese Orthopaedic Association Scores,JOA)17分法。将患者术前原始DICOM格式颈椎三维CT数据导入三维重建软件(MIMICS 17.0;Materialise,Leuven,Belgium),对骨化物和相应累及范围的椎管进行三维重建,测量并记录患者骨化物体积及其椎管占有率(3D)、骨化物椎管占位率(2D)。[结果]根据末次随访时JOA评分的改善率(improvement rate,IR)将患者分为2组:优组(IR≥75%,19例)和非优组(IR<75%,20例)。优组骨化物椎管容积占比(3D)为(6.85±1.55)%,非优组为(10.97±3.22)%,两组比较差异有统计学意义(t=5.047,P<0.001);优组椎管占位率(2D)为(40.80±9.78)%;非优组为(52.77±14.54)%,两组比较差异有统计学意义(t=2.999,P=0.005)。骨化物椎管容积占比(3D)与JOA评分改善率具有明显负相关性(r=-0.789,P<0.001);而椎管占位率(2D)则与JOA评分改善率无相关性(r=-0.030,P=0.800)。[结论]前路治疗后纵韧带骨化症的疗效确切,骨化物椎管容积占比(3D)可以用于评估颈椎后纵韧带骨化症前路手术患者的预后,比传统的椎管占位率(2D)具有明显的优越性。     

两种不同术式治疗合并颈椎后纵韧带骨化的重度脊髓型颈椎病疗效分析

目的探讨前路、后-前联合入路两种不同术式治疗合并颈椎后纵韧带骨化(Ossificationof posterior longitudinal ligament,OPLL)的重度脊髓型颈椎病的适应证及临床疗效。方法对38例合并颈椎OPLL的重度脊髓型颈椎病患者分别行颈椎前路手术(A组,22例)和后-前联合入路手术(B组,16例)。比较两组患者椎管狭窄率、骨化节段及脊髓压迫率的差异,并根据术前及术后随访时的JOA评分,评价两组患者的神经功能恢复情况。结果所有病例随访12～30个月,平均20个月,术中未出现脊髓、椎动脉损伤等严重并发症,两组脊髓功能均获不同程度改善。A组JOA评分从术前平均(7.9+2.1)分提高至术后1年平均(13.1+1.7)分,平均改善率为(65.9+5.2)%;B组JOA评分从术前平均(6.8+1.6)分提高至术后1年平均(13.9+0.9)分,平均改善率为(69.8+4.5)%,对比两组患者疗效无统计学差异(P>0.05)。结论采用前路或后-前联合入路治疗合并颈椎OPLL的重度脊髓型颈椎病,均取得彻底的椎管减压和良好的临床疗效,根据脊髓受压程度、影像学资料、骨化范围及患者全身情况合理选择恰当的手术入路是手术成功的关键。     

分期治疗颈椎黄韧带骨化合并后纵韧带骨化症

目的回顾性分析分期后前路手术治疗颈椎黄韧带骨化(ossification of ligamentum flavum,OLF)合并后纵韧带骨化(ossification of the posterior longitudinal ligament,OPLL)的临床疗效。方法完整随访手术治疗的颈椎OLF合并OPLL患者18例,一期行后路椎板成形术,术后严密观察6~9个月,一期术后症状改善有限,影像学检查发现前方骨化的韧带压迫脊髓,二期行前路椎体次全切除并切除骨化的韧带+植骨内固定术。术前、一期和二期术后行JOA评分并计算恢复率,测量颈椎前凸值,比较术前、术后颈椎前凸值、JOA评分和恢复率。结果椎板成形术后出现不全瘫痪症状加重者1例,C5神经根麻痹症状1例,脑脊液漏3例;二期前路手术后出现脑脊液漏2例,神经根麻痹2例,保守治疗后痊愈。平均随访时间26.3个月,术前JOA评分(7.2±1.3)分,颈椎前凸值(5.7±4.1)°;一期术后JOA评分(12.6±3.8)分,改善率为(51.6±19.3)%,颈椎前凸值(9.3±3.8)°;二期术后JOA评分(14.8±1.6)分,改善率为(72.7±13.4)%,颈椎前凸值(15.5±3.2)°。JOA评分、改善率以及颈椎前凸值在一期、二期术后与术前相比差异均有统计学意义,P0.05。结论分期后前路手术治疗可明显改善OLF合并OPLL患者术后JOA评分、恢复率和颈椎前凸值,是治疗OLF合并OPLL的一种良好方式。     

颈脊髓信号改变对颈椎后纵韧带骨化手术疗效的影响

[目的]研究全椎板切除减压术(total laminectomy angioplasty)治疗的OPLL患者术前颈脊髓信号改变对术后神经功能恢复的影响。[方法]回顾性研究2012年1月~2016年1月就诊于本科并行全椎板切除减压术治疗的86例OPLL患者,根据髓内T2高信号在颈椎MRI的矢状位累及节段范围分为3组,正常组38例,单节段组29例,多节段组19例。三组患者性别、年龄、病程及减压节段等差异均无统计学意义(P>0.05),具有可比性,手术前后采用JOA评分(Japanese Orthopaedic Association Scores)评估神经功能改善情况。[结果]术后随访时间16~44个月,平均(30.10±5.20)个月。三组患者术后JOA评分和神经功能均有改善,术后3个月时JOA评分改善率在组间比较差异无统计学意义(P>0.05),在术后6个月、末次随访时正常组和单节段组JOA评分改善率明显优于多节段组,差异具有统计学意义(P<0.05),但正常组和单节段组之间的改善率差异无统计学意义(P>0.05)。[结论]OPLL患者行手术治疗可以取得较满意的效果,颈脊髓信号呈多节段改变的患者术后疗效欠佳,脊髓信号正常或者呈单节段改变的患者术后疗效差异不明显,OPLL患者术后神经功能改善情况可能与术前髓内发生的病理变化有一定关系。     

颈椎后纵韧带骨化症的手术疗效分析

目的探讨不同术式治疗颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament,OPLL）的疗效和MRIT2脊髓高信号（increased signal intensity．ISI）对预后的影响。方法分析132例因OPLL行手术治疗的病例．其中前路手术46例．后路手术59例,前后路联合手术27例。统计手术前后JOA评分及术后改善率,分析不同术式的疗效及MRIT2脊髓高信号对预后的影响。结果三组病例JOA评分均较术前明显提高,差异有统计学意义;前路组改善率为（74．95±9．83）％,后路组改善率为（69．90±9．56）％,前后路联合组改善率为（76．61±10．19）％,前路组和前后路联合组的改善率均优于后路组．差异有统计学意义;术前有ISI组改善率为（67．04±7．91）％,无ISI组改善率为（77．88±9．11）％,差异有统计学意义。结论a）三种术式均可获得较好的疗效,但前路手术和前后路联合手术的改善率优于后路手术;b）术前无MRIT2脊髓高信号者的预后相对较好。     

手术治疗颈椎后纵韧带骨化症的效果及影响因素

目的:探讨手术治疗颈椎后纵韧带骨化症(OPLL)的疗效及其影响因素.方法:2000年4月～2006年4月在我院接受手术治疗并得到随访的颈椎OPLL患者共53例,男性36例,女性17例.术前JOA评分3-12分,平均8.5±3.1分.神经症状出现时间2～81周,平均27.4±15.6周.选择术前压迫最重节段CT层面测量发育椎管面积、骨化韧带面积,计算出脊髓受压比率(骨化韧带面积/发育椎管面积),随访时测量同节段椎管扩大比率.30例采用单纯后路手术,13例行一期前后路手术,4例先行后路再行前路手术,6例单纯行前路减压.利用统计学分析软件SPSS 12.0将脊髓受压比率、术前JOA评分、手术后椎管扩大比率、手术方式选择、患者年龄、神经症状出现时间等因素与手术后JOA评分改善率进行多元相关分析.结果:随访29～101个月,平均46±16个月,术后1年JOA评分改善率为30%～72%,平均53.1%±11.4%,末次随访时JOA评分改善率为28%～68%,平均52.8%±10.5%;脊髓受压比率、术前JOA评分、手术时患者年龄与手术后JOA评分改善率之间存在相关关系,手术入路、症状持续时间、手术后椎管扩大比率与疗效无显著相关关系.结论:选择恰当的术式手术治疗颈椎后纵韧带骨化症可取得较满意的临床效果,脊髓受压严重程度、患者年龄和术前神经功能状态与疗效有相关关系.     

不同手术入路治疗颈椎后纵韧带骨化症疗效的Meta分析

[目的]系统评价前路或后路入路治疗颈椎后纵韧带骨化症的疗效。[方法]计算机检索PUBMED、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库以及万方数据库中关于前路或后路入路治疗颈椎后纵韧带骨化症的相关研究,对手术时间、术中出血量、术后末次随访JOA评分、颈椎曲度改善率、并发症率等数据行Meta分析。[结果]共有8篇研究纳入,收集病例541例,其中前路组210例,后路组331例。两组相比,末次随访JOA评分、术后颈椎曲度改善率,前路优于后路(P0.01),手术时间、术中出血量后路少于前路(P0.05),并发症发生率两组差异无统计学意义。[结论]对于后纵韧带骨化症的治疗,前路手术神经功能恢复及曲度改善较好,后路手术创伤较小,尚不能认为两种入路术后并发症发生率不同,更高等级的临床证据需纳入更多高质量研究支持。     

脊髓型颈椎后纵韧带骨化症的手术治疗

[目的]比较分析不同手术入路治疗脊髓型颈椎后纵韧带骨化症的疗效及并发症.[方法]回顾性分析本院自2005年1月～2009年3月56例脊髓型颈椎后纵韧带骨化症患者的手术人路、手术方式、手术时间、出血量、手术疗效及其并发症.[结果]56例患者随访20个月～6年,平均3.8年;前路手术25例,手术时间为(220.00±35.82)min,术中出血量为(280.00±127.48)ml,术前JOA评分8.36±1.41,术后JOA评分13.52±2.00,改善率为61.92％±16.46％,并发症发生7例;后路手术21例,手术时间为(118.57±22.20)min,术中出血量为(414.29±200.71)ml,术前JOA评分8.23±1.67,术后JOA评分13.19±1.97,改善率为58.57％±15.36％,并发症发生5例;前后联合手术10例,手术时间为(309.00±51.09)min,术中出血量为(760.00±337.30)ml,术前JOA评分7.40±1.07,术后JOA评分13.70±1.64,改善率为66.60％±13.29％,并发症发生3例;三组病例术中出血量、手术时间行组间比较有显著性差异(P＜0.05),但三组术前JOA评分、术后JOA评分、术后改善率、手术并发症发生例数行组间比较无显著性差异(P＞0.05).[结论]脊髓型颈椎后纵韧带骨化症前、后路或前后联合入路手术疗效均良好,手术并发症发生率均比较高,因此脊髓型颈椎后纵韧带骨化症的手术入路选择,除了要全面考虑患者病情,同时必须兼顾自身技术特点及条件,只要能够安全地对脊髓进行充分减压,维持或重建颈椎的稳定性,三种治疗方案均是可以选择的治疗手段,但前后联合人路手术时间长、出血量大,宜慎重.     

颈椎后纵韧带骨化症的手术治疗及前后路手术比较

目的总结分析手术治疗颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament, OPLL）的结果,比较颈前路与颈后路手术治疗OPLL的优缺点。方法从2009年1月到2011年7月手术治疗颈椎OPLL患者22例,其中10例采用颈前路椎体次全切除＋骨化灶切除＋植骨钢板内固定术,12例采用颈后路全椎板切除减压术。比较前路与后路术前的基本因素（年龄、性别、随访时间、病程、骨化灶累计节段数、椎管狭窄率、术前日本骨科协会（Japanese orthopaedic association,JOA）评分）、手术时间、出血量、并发症及两组术后JOA评分、JOA评分改善率、手术优良率之间的差别。结果所有患者均获随访,平均随访时间22．5个月,最短9个月,最长38个月。a）手术前后JOA评分有显著性提高（P值小于0．001）,总计平均增加4．77分,前路组平均增加4．80分,后路组平均增加4．75分。b）JOA平均改善率为72．25％,前路平均改善率为73．26％,后路为71．40％。C）手术优良率为77．3％。前路优良率为80％,后路优良率为75％。d）颈前路、颈后路手术时间出血量差异无统计学意义。e）前路与后路两组术前的基本因素（年龄、性别、随访时间、病程、骨化灶累计节段数、椎管狭窄率、术前JOA评分）差异无统计学意义,比较两组术后JOA评分、JOA评分改善率及手术优良率,两组间差异亦无统计学意义,但是前路手术更容易发生脑脊液漏的并发症（2／10）,而后路无一例发生。结论对于颈椎OPLL患者,行颈前路椎体次全切除＋骨化灶切除＋植骨钢板内固定术或颈后路全椎板切除减压术的手术短期疗效是满意的。前路与后路手术疗效无明显差异,手术入路的选择应取决于不同患者的特点和外科医生的经验。     

单开门术后前方残留压迫阻碍神经功能恢复的研究

[目的]研究后路单开门成形术后脊髓前方残留压迫对神经功能恢复的影响,并探讨残留压迫与术前椎管侵占率以及致压物最大径之间的关系.[方法] 2008年1月～2010年12月在本院行单开门手术的脊髓型颈椎病患者60例,所有患者均获得随访.平均随访时间34个月(12 ～52个月).将患者分为两组,A组:22例术后存在前方残留压迫;B组:38例术后不存在前方残留压迫.比较和分析两组术后疗效及影像学资料,如JOA总体评分及改善率,JOA各项评分及改善率,术前及术后颈椎曲度,前方压迫物最大径以及椎管侵占率.[结果]两组平均年龄、病程、随访时间、术前JOA评分以及术前术后的颈椎曲度比较均无统计学差异(P＞0.05).A组JOA改善率(52.7±19.2)％,B组改善率(69.8±9.8)％,两组间改善率比较有统计学差异(P＜0.05),A组vs B组上肢运动功能改善率(44.6％ vs76.3％),下肢运动功能改善率(43.2％ vs57.2％),两组间比较有统计学差异(P＜0.05).A组压迫物最大径及椎管侵占率分别为(7.2±1.4) mm和(58.2±10.7)％,B组分别为(5.9±1.3)mm和(49.5±10.6)％,两组间比较有统计学差异(P＜0.05).[结论]单开门术后脊髓受到前方残留压迫时会阻碍神经功能的恢复,特别是在四肢运动功能方面.单开门手术对伴有前方巨大占位的脊髓型颈椎病的治疗具有局限性.     

颈椎后纵韧带骨化症手术并发症探讨

[目的]探讨颈椎后纵韧带骨化症（OPLL）手术主要并发症的原因及对策。[方法]对2002年3月~2006年5月85例颈椎后纵韧带骨化症手术治疗病例进行回顾性分析。其中连续长节段骨化行颈后路全椎板切除减压内固定68例,发生并发症13例;孤立型或短节段骨化行颈前路椎体次全切减压植骨内固定17例,发生并发症3例。[结果]术后获得随访66例,随访期3~25个月,平均13个月。颈后路并发症：颈肩痛8例,给予消炎止痛药、脱水、理疗等保守治疗,术后2~20周患者疼痛缓解,恢复基本满意,其主要原因与减压后脊髓漂移神经根受牵拉或手术操作导致神经根受刺激或损伤有关。2周内缓解者可能与手术创伤局部组织水肿肌肉痉挛所致。术后不全瘫或症状加重4例,经药物及高压氧等治疗,3例恢复理想,1例恢复欠佳,不全瘫发生主要与手术减压后脊髓再灌注损伤有关。术后血肿2例,均经及时发现即刻手术探查血肿清除、激素冲击治疗而获得恢复,术中止血不彻底或手术创面渗血、引流管引流失败是其主要原因。脑脊液漏1例,经脱水、局部适当包扎及颈部制动,于术后3d脑脊液漏停止,切口愈合良好。手术切口感染2例,经抗感染、局部清创缝合等治疗术后20d左右获得愈合。前路并发症：术后不全瘫2例,经甲强龙冲击,神经营养药（弥可保）、高压氧治疗,术后20~30d完全恢复;脑脊液漏1例。内置物相关并发症：前路钛网下沉1例,后路内固定螺钉脱落1例（单枚）。[结论]颈椎后纵韧带骨化无论行后路或前路手术可发生多种并发症,有些是难以避免的,而有些则是可以经过努力预防或杜绝的,术前准备充分,术中小心操作,术后加强管理,是减少后纵韧带骨化手术并发症的关键。     

Significance of segmental instability in cervical ossification of the posterior longitudinal ligament and treated by a posterior hybrid technique

Study design

Retrospective cohort case study.

Objective

To evaluate significance of segmental instability (SI) in cervical ossification of the posterior longitudinal ligament (OPLL) myelopathy and effectiveness of a posterior hybrid technique in the treatment of OPLL associated with SI.

Summary and background data

Some studies suggested both static and dynamic compression factors accounted for the pathogenesis of myelopathy in the OPLL patients.

Method

Between May 2005 and August 2007, 15 patients with multilevel cervical OPLL, diagnosed to be associated with SI, were treated by a posterior hybrid technique including laminoplasty and fusion at instable levels with lateral mass screw fixation. Another 15 cohort patients without SI treated by laminoplasty in the same period were included in the control group. Radiological and clinical data were compared between two groups.

Results

There were no significant differences in Preop. lordotic angle, extent of OPLL, type of OPLL and occupying rate, but more patients tended to present high-intensity zone (HIZ) on MRI in the group with SI. In 15 patients with SI, 17 intervertebral levels had SI, which were distributed at the noncontinuous levels of mixed-type OPLL or the adjacent levels of continuous-type OPLL. They were also consistent with the presence of HIZ levels in the major of patients. After operation, the lordotic angle was maintained well by the posterior hybrid technique in the OPLL with SI group, and was significantly greater than that in the OPLL without SI at the 3- and 4-year follow-up point. Postoperative kyphotic change of the cervical spine and postoperative progression of the ossified lesion were not observed in the OPLL with SI group, but they were respectively observed in four cases (26.7 %) and two cases (13.3 %) in the OPLL without SI group at the 4-year follow-up point. The preoperative C-JOA score in the OPLL with SI group was lower than that in the OPLL without SI group. The average C-JOA score and improvement rate were comparable in the first 2 years after operation between two groups, but there was a decrease in C-JOA score and improvement rate in the following 2 years in the OPLL without SI group. At the 3- and 4-year follow-up points, both postoperative C-JOA score improvement rate in the OPLL with SI group were superior to those in the OPLL without SI group. Each group had one case developing C5 palsy, but three cases in the OPLL without SI group developed late neurological deterioration due to postoperative kyphotic change or progression of the ossified lesion.

Conclusions

Segmental instability, a degenerative dynamic factor, is important to the OPLL myelopathy. The posterior hybrid technique seemed to be effective and safe in the treatment of selective OPLL patients associated with SI. The benefits may include providing stabilization environment for spinal cord recovery, and preventing progressive kyphotic change and progression of OPLL.     

Management of thoracic myelopathy caused by ossification of the posterior longitudinal ligament combined with ossification of the ligamentum flavum—a retrospective study

Background contextOssification of the posterior longitudinal ligament (OPLL) or ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy and is relatively common in the Japanese population and literature. However, no series of OPLL combined with OLF has been previously published. Many different surgical procedures have been used for the treatment of thoracic OPLL or OLF. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical treatment of thoracic OPLL combined with OLF have also not been established.PurposeTo compare the effect of thoracic myelopathy treatment and safety of posterior decompression with or without instrumented fusion and circumferential spinal cord decompression via a posterior approach in Chinese patients of OPLL combined with OLF at a single institution.Study designThis retrospective clinical study of 31 cases was conducted to investigate the clinical outcomes of three kinds of surgical procedures for thoracic myelopathy caused by OPLL combined with OLF in Chinese population.Patient sampleProcedure was performed in 31 patients.Outcome measuresNeurologic status was evaluated using the Japanese Orthopaedic Association (JOA) score and Hirabayashi recovery rate before and after surgery.MethodsA total of 31 patients who underwent surgery for thoracic OPLL combined with OLF were classified into three groups: posterior decompression group (13 patients); circumferential decompression group (seven patients), which included four who underwent extirpation and the other three underwent the floating procedure; and posterior decompression and fusion group (11 patients), all of whom underwent laminectomy with posterior instrumented fusion. In each group, JOA score was used to evaluate thoracic myelopathy, and Hirabayashi recovery rate was calculated 1 year after surgery and at final examination.ResultsMean recovery rate at the final follow-up was 46.5% in the posterior decompression group, 65.1% in the circumferential decompression group, and 62.7% in the posterior decompression and fusion group. Postoperative paralysis occurred in three patients in the posterior decompression group, one in the circumferential decompression group, and one in the posterior decompression and fusion group. In the circumferential decompression group, leakage of cerebrospinal fluid occurred in four patients. Urinary tract infection occurred in two patients, and superficial wound disruption occurred in one patient. Late neurologic deterioration occurred in four patients in the posterior decompression group. There were no cases of postoperative paralysis or late neurologic deterioration in the posterior decompression and fusion group.ConclusionsThoracic OPLL combined with OLF is an uncommon cause of myelopathy in the Chinese population. It can present acutely after minor trauma. A considerable degree of neurologic recovery was obtained by posterior decompression with instrumented fusion, despite the anterior impingement of the spinal cord by the remaining OPLL. In addition, the rate of postoperative complications was low with this procedure. We consider that one-stage posterior decompression and instrumented fusion be selected for patients in whom the spinal cord is severely damaged before surgery and/or when circumferential decompression is associated with an increased risk.     

Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options

OBJECTIVE: Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine produces myelopathy through anterior spinal cord compression that is usually progressive and unaffected by conservative treatment. Therefore, early decompressive surgery is imperative. However, decompression surgery of thoracic myelopathy is difficult, and the outcome is often poor. A retrospective study was conducted to investigate the surgical outcome of 21 patients with thoracic OPLL to evaluate which type of surgical approach is better and which type of thoracic OPLL results in a better surgical outcome. METHODS: A total of 21 patients with thoracic OPLL (10 men and 11 women; mean age 54 years), who underwent surgical treatment at our department from March 1985 to October 2000, were included in the study. Seven patients exhibited the flat-type OPLL and underwent either anterior decompression and fusion (one patient), anterior decompression via a posterior approach (three patients), or expansive laminoplasty (three patients). Fourteen patients exhibited the beak-type OPLL and also underwent either anterior decompression and fusion (two patients), anterior decompression via a posterior approach (six patients), or expansive laminoplasty (six patients). RESULTS: Regarding of operative time and blood loss, there were no marked differences between the two types of OPLL, regardless of the type of surgical procedure; anterior decompression and fusion and anterior decompression via a posterior approach yielded longer operative times and larger blood loss volumes than expansive laminoplasty. Concerning clinical outcome, there were five cases of neurologic deterioration. All of the five deteriorated cases were of the beak-type OPLL treated by a posterior approach. Two of these patients were treated with expansive laminoplasty. CONCLUSIONS: There were five instances of neurologic deterioration in our thoracic OPLL series, and all of them exhibited beak-type OPLL. In the beak-type OPLL, a subtle alteration in the spinal alignment during posterior decompression procedures may increase spinal cord compression, leading to the deterioration of symptoms. A potential increase in kyphosis following laminectomy should be avoided by fixation with a temporary rod. If intraoperative monitoring suggests spinal cord dysfunction, an anterior decompression procedure should be attempted as soon as possible.     

腰椎间盘前缘与后缘高信号区的临床对照研究

目的 通过与腰椎间盘后缘高信号区(HIZ)比较,探讨前缘HIZ的发生规律、分布及临床意义.方法 根据HIZ的诊断及定位,将610例有完整临床资料的腰椎MRI,依据有无HE及其发生部位分为对照组(无HIZ),前缘组,后缘组和前后缘组.统计总样本中HIZ发生率,对比分析各组性别比例、年龄、体重、腰痛发生率及HIZ分布规律.结果 610例患者中,对照组315例(51.6%),前缘组95例(15.6%,119个椎间盘),后缘组159例(26.1%,189个椎间盘),前后缘组41例(6.7%,96个椎间盘).前、后缘组发生率间存在显著的统计学差异(P<0.01).各组的性别构成和体重载明显差异(P>0.05),年龄间存在显著的统计学差异(P<0.01,对照组<后缘组<前后缘组<前缘组).前缘组多见于L1,2～L4,5,后缘多位于L3,4～L5S1对照组、前缘组、后缘组和前后缘组腰痛发生率分别为40.0%,52.6%,55.4%和65.8%,对照组明显低于其他三组(P<0.05),后三组间差异无统计学意义(P>0.05).结论 与纤维环后缘HIZ相比,前缘HIZ发生率较低,患者年龄较大,发生节段较高,与腰痛症状亦明显相关.     

Surgical treatment of lumbar ossification of the posterior longitudinal ligament. Report of two cases and description of surgical technique

The authors report two cases of patients with lumbar ossification of the posterior longitudinal ligament (OPLL). One patient underwent surgery via the single posterior approach, and the other patient underwent combined anterior-posterior surgery. The authors consider the anterior approach for excision of the ossified lesion to be the most reasonable for treatment of lumbar OPLL. It is extremely important, however, to select the surgical procedure according to the individual patient's condition.     

Conservatively treated ossification of the posterior longitudinal ligament increases the risk of spinal cord injury: a nationwide cohort study

The optimal treatment strategy for ossification of the posterior longitudinal ligament (OPLL) depends on symptoms and is uncertain. Whether the risk of spinal cord injury (SCI) is increased in patients with cervical spinal stenosis or myelopathy caused by OPLL remains unclear. This study aimed to evaluate the risk of SCI in patients with OPLL of the cervical spine when managed with conservative treatment (no surgery). Study subjects were identified from a nationwide cohort of 26,544,883 people from 1998 to 2005 and were divided into the OPLL group (n=265), who were hospitalized for OPLL but had conservative treatment (no surgery), and the comparison group (n=5339), composed of age- and sex-matched people. Until the end of 2008, a total of 5604 subjects were followed-up for 34,723.5 person-years. The propensity score method was used to adjust for covariates. Kaplan-Meier and Cox regression analyses were performed. The incidence rate of cervical SCI in the OPLL group was found to be significantly higher than in the comparison group (4.81 versus 0.18 per 1000 person-years; p<0.001). Cervical SCI was more likely to happen in the OPLL group than in the comparison group (crude hazard ratio [HR] 25.64; p<0.001). After adjustments, the OPLL group had a 32.16-fold (p<0.001) higher risk for cervical SCI. Disability caused by SCI had an even higher risk (HR=110.72, adjusted HR=104.78; p<0.001) for the OPLL group. Therefore, cervical SCI and related disabilities are more likely to happen in OPLL patients, who should be cautioned for subsequent SCI if treated conservatively.     

胸椎后纵韧带骨化致椎管狭窄症的临床特征和手术治疗方法

目的 探讨胸椎后纵韧带骨化致椎管狭窄症的临床特征和手术治疗方法.方法 2004年1月至2009年3月,手术治疗胸椎后纵韧带骨化致椎管狭窄症患者21例,男13例,女8例;年龄34～71岁,平均51.2岁;病程2～50个月,平均11个月.病变位于上胸段(T1～T4)4例,中胸段(T5～T8)7例,下胸段(T9～T12)10例;合并黄韧带骨化9例,合并颈椎后纵韧带骨化8例.11例行后路椎板切除术,10例行侧前方减压术.结果 后路椎板切除手术时间90～240 min,平均140 min.侧前方减压手术时间110～360min,平均240min.术后患者症状未加重,未出现神经系统并发症、无蛛网膜下腔感染和伤口感染.术后6个月日本骨科协会(Japanese Orthopaedic Association,JOA)评分为8～15分,平均(9.17±1.63)分;其中神经功能改善率8例为优,6例为良,5例为可,2例为差,优良率为66.7%.术后12个月JOA评分为8～15分,平均(10.23±1.64)分;其中神经功能改善率8例为优,7例为良,4例为可,2例为差,优良率为71.4%.结论 胸椎后纵韧带骨化致椎管狭窄临床表现多样,常合并颈椎后纵韧带骨化和黄韧带骨化,后路椎板切除术和侧前方减压术有较好疗效.