胸椎黄韧带骨化的临床病因分析

目的 通过对142例胸椎黄韧带骨化症（TOLF）患者临床资料及影像学特点的回顾性研究,从临床的角度探讨该病的不同病因.方法 1989年7月至2005年11月,收治胸椎黄韧带骨化症142例,手术治疗121例.从临床病因学的角度分为三大类型：（1）原发性TOLF（组1,90例）,不合并与黄韧带骨化相关的疾病,且Ca、P、AKP均正常;（2）全身骨化疾病性TOLF（组2,30例）,其中强直性脊柱炎6例,弥漫性特发性骨肥厚症（DISH）3例,氟骨症10例,后纵韧带骨化症（OPLL）11例;（3）脊柱局部病变性TOLF（组3,22例）,其中陈旧性脊柱骨折5例,脊柱结核4例,椎体后缘骨内软骨结节13例.分析各组临床及影像特点,并测量胸椎、胸腰段后凸角,椎体楔变角.按Epstein标准评定手术效果.结果 （1）组1病变类型以连续型居多（67/90,74%）,以局灶型最少（4/90,5%）;组2中,以连续型居多（21/30,70%）,无局灶型病例,发病节数最多（平均每例6.2节）;组3以局灶型多见（18/22,82%）.（2）组1下胸椎及胸腰段最多见（225/486,47%）;组2中病变多累及整个胸椎,12例颈椎、腰椎同时发生OLF;组3骨化部位与原发疾病部位相近.（3）组1 81%（73/90）胸椎曲度无异常,组2 87%（26/30）有异常,组3 82%（18/22）无异常.结论 TOLF由不同病因引起,本研究发现与全身骨化性因素、脊柱的载荷改变、退变等因素有关;应根据病因进行临床分类.

The clinical causes of the thoracic ossification of ligamentum flavum

Objective To assess the different causes of thoracic ossification of the ligamentum flavum(TOLF).Methods From July 1989 to November 2005,142 cases were diagnosed the TOLF,in which 121 were operated.The lesions were classified into three types on the basis of the clinical result:(1) In such primary group(Group 1,90 cases),without incorporation disease and Ca,P and AKP was all normal;(2)In systemic ossified TOLF group(Group 2,30 cases),6 cases ankylosing spondylitis,3 cases DISH,10 cases fluorosis,11 cases OPLL;(3)In local spine disease group(Group 3,22 cases),5 cases fracture in spine,4 cases spine TB,13 cases posterior marginal intraosseous cartilaginous node.Such clinical feature was analysed,moreover surveyed the thoracic kyphosis angle,upper thoracic kyphosis angle, lower thoracic kypbosis angle and the vertebra body wedge change.The effect was assessed using Epstein Scale.Results (1)In Group 1,the mainly type was connected type(67/90,74%).The ossified ligamentum flavum was mainly located at the lower thoracic and thoracic-lumber levels.The local type was less.In Group 2,the mainly type was connected type(21/30,70%).The local type was none.The lesions figure was the most.In Group 3,the local type was the most(18/22,82%).(2)In Group 1,the ossified ligamentum flavum was mainly located at the upper and lower thoracic levels(225/486,47%).In Group 2, mainly located at the whole thoracic,some include cervix and lumber.In Group 3,mainly location was related with the location of primary disease.(3)In group 1,the curve was normal in 81%(73/90)of cases.In Group 2,the curve was abnormal in 87%(26/30)of cases.In Group 3,the curve was normal in the 82%(18/22)of cases.Conclusions The TOLF relates with systemic ossify disease,the change of load on the spine,aging and so on.It should be classified according to its causes.