胸椎后纵韧带骨化的临床特点及治疗策略

目的回顾研究手术治疗胸椎后纵韧带骨化症(OPLL)的临床特点及治疗方法。方法1991至2005年手术治疗胸椎OPLL55例,男19例,女36例;年龄35～73岁,平均51.9岁。均伴有脊髓损害。手术方式包括单纯椎管后壁切除术34例、前方OPLL切除减压术15例以及前后路联合手术6例。结果55例中36例(65.5%)合并胸椎黄韧带骨化(OLF),18例(32.7%)合并颈椎OPLL。单纯发生于上胸椎的OPLL13例(23.6%),中胸椎12例(21.8%),下胸椎及胸腰段17例(30.9%),广泛分布者13例(23.6%)。43例获得随访,平均随访时间47.1个月(6～168个月)。37例神经功能有改善,改善率为76.6%,无改善2例,加重4例。前方入路获随访者13例,其中3例症状加重,余改善率平均为82.9%(42.9%～100%)。后路椎管后壁切除术获随访者25例,1例无改善,1例加重,余改善率平均为72.6%(22.2%～100%)。前后路联合手术获随访5例,1例无改善,余改善率平均为83.9%。结论胸椎OPLL常合并胸椎OLF及颈椎OPLL。上胸椎OPLL合并颈椎管狭窄可一期行颈后路单开门及上胸椎椎管后壁切除术。两个节段以内的OPLL且不合并有造成脊髓压迫的胸椎OLF可行前路OPLL切除减压术,否则行后路椎管后壁切除术。单节段的OPLL合并胸椎OLF可行前后路联合手术。

Clinic characteristics and surgical strategy of ossification of the posterior longitudinal ligament of thoracic spine

Objective To study the ossification of the posterior longitudinal ligament(OPLL) of thoracic spine which treated surgically, analysis the clinic characteristics and surgical strategy. Methods Fifty-five patients who had been treated surgically for thoracic OPLL were reviewed. There were 19 males and 36 females. The mean age was 51.9 years (range, 35~73 years). All cases were with neurological deficits. The treatment procedures consisted of anterior decompression with instrumentation (15 patients), posterior removal of posterior wall of thoracic spinal canal (34 patients), combined anterior and posterior decompression (6 patients). Results 65.5% of the cases were combined with thoracic ossification of ligamentum flavum (OLF), 32.7% of the cases with cervical OPLL. Among the 55 cases, 23.6% of thoracic OPLL were found in upper thoracic spine, 21.8% in middle thoracic spine, 30.9% in lower thoracic spine and thoracolumbar spine, and 23.6% were distributed abroadly. 43 cases were followed up. The mean follow-up period was 47.1 months (range, 6 to 168 months). 37 cases showed an improvement in neural function, the improvement rate was 76.6%, 2 cases unchanged, 4 cases aggravated. In 13 patients who underwent anterior decompression, 3 cases were aggravated, the rest were with the neural improvement rate of 82.9% (42.9%~100%). In 25 patients who underwent removal of posterior wall of spinal canal, 1 case was aggravated, 1 case was unchanged, 23 cases achieved neural improvement rate of 72.6%(22.2%~100%). In 5 patients who underwent combined anterior and posterior approaches, 1 case was unchanged, 4 cases were with neural improvement rate of 83.9%. Conclusion It was frequently that thoracic OPLL was combined with OLF and cervical OPLL. OPLL of upper thoracic spine combined with cervical OPLL should be treated with removal of posterior wall of thoracic spinal canal and posterior cervical laminoplasty together. Thoracic OPLL less than three segments involved and without OLF which compressing spinal cord should be treated anteriorly, otherwise should be treated with removal of posterior wall of spinal canal. Thoracic OPLL occurred in one segment with OLF could be treated with combined anterior and posterior approaches.