胸椎后纵韧带骨化症术后临床疗效及其相关因素分析

目的：探讨胸椎后纵韧带骨化症减压融合术后的临床疗效及其相关因素。方法：2000年1月一2011年1月，我院共收治胸椎后纵韧带骨化症患者64例，其中男39例，女25例，年龄42。67岁，平均54．1岁。采用后路椎板广泛切除、减压、植骨融合治疗者36例，采用前路减压、植骨融合治疗者12例，后外侧经关节突减压植骨融合者9例，前后路联合减压植骨融合者7例。评估患者的年龄、病程、影像学表现、病变类型、手术方式、术前合并疾患，及术后并发症和手术疗效的关系。手术疗效采用JOA评分及其改善率进行判定。结果：所有患者均获得随访，平均随访时间4．6年（1—12年）。术前平均JOA评分为（4．5±1．9）分，末次随访时（7．8±2．1）分，平均改善率为（48．4±38．1）％。后路椎板广泛切除、减压、植骨融合组为（37．6±36．8）％，前路减压、植骨融合组为（62．9±32．6）％，后外侧经关节突减压植骨组为（30．8±29．2）％，前后路联合减压植骨融合组为（59．5±39．1）％。患者的术前病程、年龄、手术方式，、MRI检查T2WI信号改变，及是否合并糖尿病对术后疗效有显著影响（P〈0．05）。30例（46．9％）患者合并术后1种或多种并发症：17例患者术后神经功能恶化，12例患者合并脑脊液漏，3例患者硬膜外血肿形成，5例合并肺部感染。结论：对于胸椎后纵韧带骨化症外科治疗可以获得较好的疗效，患者术前病程、年龄、手术方式、MRI检查T2WI信号改变，及是否合并糖尿病是影响手术疗效的主要因素。

Outcomes and related factors of surgery for ossification of the posterior longitudinal ligament of the thoracic spine

Objective： To evaluate the outcomes of decompression and fusion surgery in patients with ossification of the posterior longitudinal ligament in the thoracic spine （T-OPLL）, and to identify the factors that related to the surgical outcomes. Methods： The study included 64 T-OPLL patients （39 men and 25 women with a mean age of 54.1 years）. All patients underwent the surgery in our hospital from January 2000 to January 2011, among them, posterior wide laminectomy, decompression and bone fusion were performed in 36 patients （group A）; decompression and bone fusion were performed in 12 patients by anterior （group B）, in 9 patients by posterolateral （group C）, in 7 patients by anterior and posterior approaches （group D）. The relationship between the surgical outcomes and clinical factors such as age, course of disease, radiological findings, classification, preoperative comorbidities, surgical methods and post-op complications were assessed. Surgical outcomes were assessed using the Japanese Orthopaedic Association （JOA） scale score for thoracic myelopathy （11 points） and the recovery rate. Results： All patients were followed up for an average time of 4.6 years （ranged from 1 to 12 years）. The mean JOA scale score was improved from 4.5＋1.9 preoperatively to 7.8~2.1 at the final follow-up examination, with a mean recovery rate of （48.4＋38.1）%. The recovery rates by surgical method were （37.6~36.8）%, （62.9＋32.6）%, （30.8＋29.2）% and （59.5~39.1）% in group A, B, C and D respectively. The factors had a significant influence on the post-op curative effects （P〈0.05）. After surgery, one or more complications were noted in 30 patients （46.9%）, neurological deterioration in 17 patients, leakage of cerebrospinal fluid in 12 patients, epidural hematomas in 3 patients and pulmonary infection in 5 patients. Conclusion： For T-OPLL patients, patients age, course of disease, radiological findings, surgical methods and whether combine with diabetes or not are the main influence factors for the clinical outcome.