胸椎黄韧带骨化症的诊断和治疗

目的探讨胸椎黄韧带骨化症的诊断特点及改良手术的疗效。方法总结我院1995年至2002年收治的胸椎黄韧带骨化症病人并对手术疗效加以分析。结果16例病例，随访6～36个月，平均22个月。术后JOA评分为6～11分，平均9．5分，恢复率为73．9％，优良率为83．5％。结论临床表现结合CT及MRI检查是诊断胸椎管狭窄的有效手段，改良的外科技术较为安全可靠，手术疗效佳。     

胸椎黄韧带骨化合并硬脊膜骨化的手术策略

目的介绍黄韧带骨化合并硬脊膜骨化的手术策略并讨论手术的可行性。方法 2006年6月-2009年12月收治黄韧带骨化致胸椎管狭窄患者98例,其中18例经手术证实合并硬脊膜骨化。男11例,女7例;年龄46～73岁,平均58岁。病程5～48个月,平均20个月。所有患者均由于症状加重选择后路减压术,通过根黄通道八边形游离整块切除胸椎上关节突及骨化黄韧带和硬脊膜。手术前后采用日本骨科协会(JOA)评分、改良Oswestry功能障碍指数(ODI)和Cobb角测量进行疗效评价。结果术后患者初始症状均明显缓解。术后18例均出现暂时性脑脊液漏,保守治疗8～10 d后脑脊液漏停止。患者伤口均Ⅰ期愈合,无神经症状加重、蛛网膜下腔感染、伤口感染、窦道形成等并发症发生。18例均获随访,随访时间20～60个月,平均49个月。末次随访时无脊髓压迫复发、神经症状加重等。术后1、12个月患者JOA评分及ODI值均较术前明显改善(P<0.05);术后12个月JOA评分及疗效、ODI值均较术后1个月明显改善(P<0.05)。术后12个月患者Cobb角(8.0±1.2)°与术前(6.7±1.6)°比较差异有统计学意义(t=4.000,P=0.001)。术后2个月MRI水平位、矢状位和脂肪抑制像上显示受压节段脊髓膨起良好。结论根黄通道八边形游离整块切除胸椎上关节突及骨化黄韧带和硬脊膜的手术方法,对于治疗继发于黄韧带骨化和硬脊膜骨化的胸椎管狭窄安全可靠,无修补的方法对于硬脊膜缺损的处理也有效。     

胸椎黄韧带骨化症的手术方法选择

目的 探讨不同类型胸椎黄韧带骨化症的手术方法.方法 1994年1月至2008年6月,手术治疗56例胸椎黄韧带骨化症患者,男40例,女16例;年龄43～76岁,平均58.1岁;病程3个月至5年,平均13.4个月.通过CT及MR检查观察骨化累及节段、分布特点、骨化巢形态、椎管狭窄程度以及脊髓压迫程度等.患者均采用全椎板整块或分解切除加后外侧融合术进行治疗.术后手术疗效采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分进行评价.结果 术后患者均获得随访,随访时间18～70个月,平均25个月.JOA评分由术前平均(6.25±2.47)分(0～10分)改善至末次随访时(7.53±3.20)分(0～11分).术后恢复率为-116.7%～100%;56例中优25例,良20例,可6例,差5例,优良率80.4%.CT扫描显示根据骨化巢形态胸椎黄韧带骨化分为外侧型6例,弥漫型17例,厚结节型33例.6例外侧型患者采用整块全椎板切除法,手术优良率为83.3%(5/6);弥漫型患者中,采用整块全椎板切除法11例、椎板分解切除法6例,手术优良率分别为81.8%(9/11)、83.3%(5/6);厚结节型患者中,采用整块全椎板切除法4例、椎板分解切除法29例,手术优良率分别为50%(2/4)、82.8%(24/29),并各有2例术后疗效差.结论 全椎板整块切除加后外侧融合适用于治疗外侧型、弥漫型胸椎黄韧带骨化,而全椎板分解切除法加后外侧融合适用于厚结节型胸椎黄韧带骨化.     

胸椎黄韧带骨化症的手术治疗

目的探讨胸椎黄韧带骨化症的手术治疗效果。方法MRI及CT检查确定病变范围后,手术治疗黄韧带骨化所致胸椎管狭窄症患者12例38个节段（下胸段22个,中胸段6个,上胸段10个）,均采用磨钻加＂揭盖法＂切除椎管后壁减压。结果12例均获随访,时间6～41个月。参照Epstein et al标准评分：优6例,良4例,可2例。结论临床表现结合MRI及CT检查是诊断胸椎黄韧带骨化症的有效手段;用磨钻加＂揭盖法＂切除椎管后壁减压是安全、有效的方法。     

后路漂浮法减压内固定治疗严重黄韧带骨化型胸椎管狭窄症

目的探讨经后路漂浮法减压及内固定术治疗严重黄韧带骨化型胸椎管狭窄症的疗效。方法 2007年1月至2010年10月,我科收治严重黄韧带骨化型胸椎管狭窄症15例,根据Miyakoshit分型均为融合型,其中男7例,女8例;年龄40～67岁,平均56岁。所有患者术前均行X线、CT、MRI检查,并采用后路漂浮法减压+椎弓根钉内固定术。通过JOA评分、并发症发生情况评估疗效。结果术后15例均获得随访,随访5个月～3年,平均10.3个月。根据JOA评分进行疗效评价,优10例,良3例,可2例,优良率86.7%。其中2例出现硬脊膜撕裂,经腰背筋膜修复后痊愈。结论后路漂浮法可以安全有效地对受压胸髓实现减压,椎弓根钉内固定可以提供脊柱稳定,是治疗黄韧带骨化型胸椎管狭窄症的良好术式。     

胸椎黄韧带骨化症临床研究

目的 探讨胸椎黄韧带骨化症的诊断特点及改良手术的疗效。方法 总结我院从1995～2005年收治的28例胸椎黄韧带骨化症的患者并对其手术疗效加以分析。结果28例患者全部获得随访，随访时间6～36个月，平均23个月。术后JOA评分为6～11分，平均9．3分，恢复率为73．6％，优良率为84．5％。结论临床表现结合CT及MRI检查是诊断胸椎黄韧带骨化症的有效手段，改良的外科手术方式安全可靠，手术疗效佳。     

黄韧带骨化所致胸椎管狭窄症的诊断及手术治疗

目的：总结黄韧带骨化所致胸椎管狭窄症的诊断和治疗特点。方法：1995年9月－2000年12月手术治疗黄韧带骨化所致胸椎管狭窄症患12例，男8例，女4例，平均年龄55岁。该病常见于下胸椎，临床表现为多椎管狭窄引起的胸髓压迫症，其影像学检查具有特征性表现。所有病例均行整块半关节突全椎板切除术。结果：11例随访6－62个月，平均23个月。根据评定标准，优6例，良2例，中2例，差1例，优良率72．7％。结论：临床表现结合MRI和CT检查，是诊断胸椎黄韧带骨化的重要手段，整块半关节突全椎板切除术为治疗的有效术式。     

胸椎黄韧带骨化症的手术治疗

目的探讨胸椎黄韧带骨化症的手术治疗方法。方法回顾分析2002年1月至2008年1月我院36例胸椎黄韧带骨化症手术治疗的病例。患者均采用胸椎管后壁切除术治疗。根据日本矫形外科学会（JOA,11分）评分标准进行术前和术后的疗效评价。结果36例患者获得6～72个月随访．平均随访时间19个月。术后平均改善率66．7％,优18例,良10例,改善8例．优良率77．8％。结论胸椎黄韧带骨化症可压迫脊髓出现神经系统症状,应尽早手术治疗．根据患者病情和影像学表现．明确胸椎黄韧带骨化部位和范围,采用胸椎管后壁切除术可获得满意的疗效。     

胸椎黄韧带骨化症的诊断及外科治疗

目的探讨胸椎黄韧带骨化症的诊断特点及改良手术方法的疗效。方法14例胸椎黄韧带骨化症患者,临床主要表现为肢体麻木、感觉异常(13例),下肢无力、行走困难(11例),锥体束征阳性(12例),括约肌功能障碍(10例)。经X线初步筛查,MRI联合CT或CTM证实手术切除黄韧带骨化灶41个节段。该病常见于中下胸椎,其中T894个节段,T91010个节段,T101111个节段,T11125个节段。经后路骨化灶头尾侧“开窗”,两侧“截桥”的整体“漂浮”技术,去除骨化的黄韧带。按JOA评分及Hirabayashi恢复率评价手术效果,术前JOA评分1～8分,平均4.1分。结果14例随访6～57个月,平均23个月。术后JOA评分5～11分,平均9.4分,恢复率为76.8%优良率85.6%。手术中平均失血370ml,手术时间175min,所有病例均恢复自主活动。结论临床表现结合MRI和CT或CTM检查,是诊断黄韧带骨化症的重要手段,改良外科手术技术较为安全可靠,术后疗效满意。     

手术治疗胸椎黄韧带骨化症的疗效分析

目的探讨手术治疗胸椎黄韧带骨化症的方法和疗效。方法我院自2006年1月至2008年11月对12例胸椎黄韧带骨化症患者进行手术治疗,均采用胸椎管后壁切除术治疗,根据日本矫形外科学会JOA评分标准进行术前和术后的疗效评价。结果12例患者术后均获得6-24个月随访,平均随访时间15个月。术后优8例,良2例,改善2例,优良率83.3%。结论胸椎黄韧带骨化症可压迫脊髓出现神经系统症状,应尽早手术治疗。术前根据患者病情和影像学表现,明确胸椎黄韧带骨化部位和范围,采用手术胸椎管后壁切除术可获得满意的疗效。     

局灶性胸椎黄韧带骨化症的诊治效果分析

目的探讨局灶性胸椎黄韧带骨化（ossification of the ligamentum flavum,OLF）致椎管狭窄的临床特点、手术治疗效果及影响因素。方法对手术治疗的21例胸椎OLF病例进行回顾性研究分析,手术均采用后路椎板（半椎板或全椎板）切除减压术。采用改良胸椎日本骨科学会（Japanese Orthopaedic Association,JOA）评分法和Epstein标准评估最终随访临床效果。分析患者年龄、术前病程、椎管面积残余率和术前胸椎JOA评分与手术疗效相关性。结果术后随访平均34.3个月。JOA评分术前平均7.7分;末次随访时平均10.2分,改善率为75.8%。Epstein标准：优13例,良5例,可3例。患者椎管面积残余率、术前胸椎JOA评分与手术疗效均呈正相关,相关系数分别为0.41（P〈0.05）、0.53（P〈0.05）。结论局灶性OLF临床表现较复杂,必须根据临床特点、影像学及电生理检查进行综合分析并作出诊断。后路椎板切除减压术是治疗局灶性胸椎OLF并椎管狭窄症的有效方法。患者椎管狭窄程度、术前胸椎JOA评分是影响手术疗效的重要因素。     

Thoracic ossification of ligamentum flavum caused by skeletal fluorosis

Thoracic ossification of ligamentum flavum (OLF) caused by skeletal fluorosis is rare. Only six patients had been reported in the English literature. This study reports findings from the first clinical series of this disease. This was a retrospective study of patients with thoracic OLF due to skeletal fluorosis who underwent surgical management at the authors' hospital between 1993 and 2003. Diagnosis of skeletal fluorosis was made based on the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis was present. Neurological status was evaluated preoperatively, at the third day postoperatively, and at the end point of follow-up using the Japanese Orthopaedic Association (JOA) scoring system of motor function of the lower extremities. A total of 23 cases were enrolled, 16 (69.6%) males and 7 (30.4%) females, age ranging from 42 to 72 years (mean 54.8 years). All patients came from a high-fluoride area, and 22 (95.7%) had dental fluorosis. Medical imaging showed OLF together with ossification of many ligaments and interosseous membranes, including interosseous membranes of the forearm (18/23 patients 78.3%), leg (14/23 patients 60.9%), and ribs (11/23 patients 47.8%). OLF was classified into five types based on MRI findings: localized (4/23 patients 17.4%), continued (12/23 patients 52.2%), skip (3/23 patients 13.0%), combining with anterior pressure (2/23 patients 8.7%), and combining with cervical and/or lumbar stenosis (2/23 patients, 8.7%). Urinalysis showed a markedly high urinary fluoride level in 14 of 23 patients (60.9%). Patients were followed up for an average duration of 4 years, 5 months. Paired t-test showed that the JOA score was slightly but nonsignificantly increased relative to preoperative measurement 3 days after surgery (P = 0.0829) and significantly increased at the end of follow-up (P = 0.0001). In conclusion, Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. Comparing with other OLF series, a larger number of spinal segments were involved. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptom, imaging study findings, and urinalysis. En bloc laminectomy decompression was an effective method.     

胸椎黄韧带骨化所致椎管狭窄症的诊断及手术治疗

报告胸椎黄韧带骨化所致椎管狭窄症并手术２１例。临床表现多为椎管狭窄引起的胸髓压迫症，其影像学检查具特征性表现，故可对黄韧带骨化进行早期诊断。椎板切除减压术范围应充分，包括切除部分小关节以及骨化灶上下各一椎节的椎板。随访１８例，平均随访时间２３个月，优良率６６．７％，有效率７７．８％。     

胸椎黄韧带骨化症合并脊髓型颈椎病手术方案选择

目的 探讨胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)合并脊髓型颈椎病(cervical spondylotic myelopathy,CSM)手术方案的选择.方法 1991年1月至2003年1月,手术治疗胸椎OLF合并CMS患者56例,其中40例获得2年以上随访,男22例,女18例;确诊时年龄27～70岁,平均58岁;病程1～120个月,平均16.5个月.其中OLF 25例,OLF合并后纵韧带骨化(ossification of posterior longitudjnal ligament,OPLL)12例,OLF合并胸椎间盘突出3例;同时合并颈椎OPLL 23例,退变性颈椎管狭窄17例.18例一期行颈后路"单开门"椎板成形术+上胸椎椎管后壁切除术,9例一期行胸椎管后壁切除术,13例分期行颈后路和胸椎管后壁切除术.结果 40例患者的随访时间为24～227个月,平均67.5个月.根据改良Epstein手术疗效评定标准评价优良率,18例一期行颈后路"单开门"椎板成形术+上胸椎椎管后壁切除术者为88.9%(16/18),9例行胸椎管后壁切除术者为66.7%(6/9);13例分期行颈后路和胸椎管后壁切除术者为53.8%(7/13).结果 显示分期手术者术后优良率低于一期手术者,手术间隔时间在1年以内者的优良率高于间隔1年以上者.结论 上胸椎OLF合并CSM者应一期行颈椎和上胸椎脊髓减压术;下肢症状严重而上肢症状轻微者应先行胸脊髓减压术;上、下肢症状均重者应一期或分期行颈脊髓减压术和胸脊髓减压术,而分期手术者的手术间隔时间不宜过长.     

黄韧带骨化所致胸椎管狭窄症的临床特征

目的 总结黄韧骨化所致胸椎管狭窄症的诊断和治疗特点,探讨有关的发病因素。方法 １９７８～１９９７年手术治疗黄韧带骨化所致胸椎管狭窄症患者３５例,男２１例,女１４例,平均年龄５１岁。发病部位：Ｔ１０～Ｌ１三个椎间盘水平３０例,占８５．７％。重体力劳动者３２例,占９１．４％。有明显诱因者１６例,占４５．７％。３５例患入床症状呈多样化,但感觉定位体片明确：出现锥体吵征者１５例,占４２．９％,未出现者１３     

Thoracic cord compression caused by contiguous multilevel ossification of ligamentum flavum in Chinese patients

OBJECTIVE: To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. METHODS: Medical notes and imaging data of 18 Chinese patients (14 males and 4 females, aged 43-72 years, mean: 57 years) with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography (CT) and magnetic resonance imaging (MRI) scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty. The average follow-up duration was 34 months (range, 28-49 months). The outcome was evaluated by Japanese Orthopaedics Association (JOA) score. RESULTS: The average time for occurring clinical symptoms was 7.5 months (range, 2 days-16 months). All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3.6 (range, 0-6). MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3% (range, 33.3%-100%), with a mean final JOA score of 8.3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. CONCLUSIONS: Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum (OLF). Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.     

The CT and intraoperative observation of pedicel-ossification tunnel in 151 cases of thoracic spinal stenosis from ossification of ligamentum flavum

Purpose

The aim of this study is to precisely illustrate the pedicle-ossification tunnel (POT)—a spinal cord-free pathway in upper facet joint en bloc resection, which was reported as a comparatively neurological safer decompression surgery for thoracic ossification of ligamentum flavum (OLF).

Methods

From 1998 to 2009, 151 patients with thoracic spinal stenosis from OLF were diagnosed by CT, MRI, neurological examinations and confirmed by postoperative pathological examination. The existence and configuration of the POT were observed by interactive CT virtual endoscopic (CTVE) image with multiplanar reconstructions and confirmed by intraoperative observation. Posterior decompression by upper facet joint en bloc resection via POT was conducted in all patients and the advantage of surgery was evaluated by modified Japanese Orthopedic Association scores pre- and post-operatively.

Results

Through CTVE and intraoperative observation, no spinal cord was found present in POTs. OLF bloc divided the foramen into three parts: upper POT, OLF bloc and lower POT. The POT was the epidural space between the lateral border of OLF and its neighboring pedicles inner cortex. The recovery rate of upper facet joint en bloc resection via POT was 75.24 ± 18.01 %.

Conclusions

POT is a spinal cord-free pathway between OLF bloc and its neighboring pedicles in thoracic spinal stenosis which can be applied in neuron preserved decompression surgery.     

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.