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。

Diagnosis and treatment of isolated thoracic ossification of ligamentum flavum

Objective To explore the clinical features,surgical outcome and related factors of thoracic spinal stenosis caused by isolated ossification of ligamentum flavum(OLF).Methods Clinical data of 21 thoracic OLF patients who underwent posterior decompression(laminectomy or partial laminectomy) were analyzed retrospectively.The clinical outcome was assessed by using Japanese Orthopaedic Association(JOA) scoring system and Epstein standards at the final follow-up.The correlation between the age,duration of symptoms,OLF induced residual ratio of spinal canal,preoperative JOA score and the surgical outcome was analyzed.Results The mean duration of follow-up was 34.3 months.JOA scores were 7.7 and 10.2 before operation and at the final follow-up,respectively.The improvement rate was 75.8%.According to Epstein standard,curative effects were excellent in 13 patients,good in 5 and fair in 3.The surgical outcome was positively related to the residual ratio of spinal canal and preoperative JOA score.The coefficient of correlation was 0.41(P<0.05) and 0.53(P<0.05),respectively.Conclusion The clinical manifestation of isolated OLF is complicated.A correct diagnosis should be based on the clinical features,radiologic and electrophysiologic study.The laminectomy or partial laminectomy through posterior approach is an effective treatment for spinal stenosis caused by isolated thoracic OLF.Therapeutic effect is significantly associated with the residual ratio of spinal canal and preoperative JOA score.