氟骨症引起黄韧带骨化的临床研究

目的：分析氟骨症引起的黄韧带骨化临床及影像学特点,评价经后路全椎板切除术疗效。方法：收集2008-01～2009-12氟骨症黄韧带骨化（OLF）病例19例。病人OLF所累及脊柱水平均行后路全椎板切除术。病人术前体检,行X线平片、CT、MRI等影像学检查和尿氟测定。术后查体、复查MRI,观察病人临床恢复及椎管狭窄缓解状况。应用ASIA评估标准进行分级,手术前、后脊髓功能评分对比,评价脊髓损伤进行脊髓减压的治疗效果。术中切除组织行病理学检查,制作切片观察。结果：术后除2例长期严重截瘫病人外,余17（89.5%）例病人症状均较术前有所改善,症状明显改善12例（63.2%）。复查MRI,显示OLF累及节段椎管狭窄均明显缓解。术后病理切片示骨质硬化和软骨内成骨。结论：氟中毒是高氟地区黄韧带骨化的重要病因,可累及全脊柱大量椎体节段。MRI可明确脊髓病变情况,并为OLF术前诊断、鉴别诊断,术后评估提供依据。氟中毒椎管狭窄需早期诊断,早期手术,经后路全椎板切除术治疗有效。

THE CLINICAL STUDY ON OSSIFICATION OF THE LIGAMENTUMFLAVUM CAUSED BY SKELETAL FLUOROSIS

Objective：To analyze clinical and image characteristics of ossification of ligamentum flavum which is caused by skeletal fluorosis and evaluate the curative effect of posterior total laminectomy.Methods：19 OLF cases from Jan.2008 to Dec.2009 were collected.All patients accepted posterior total laminectomy on diseased spine and were subject to physical examination,plain film radiography examination,CT、MR examination and urine fluorine determination before operation;physical examination,MRI reexamination,observation of clinical recovery condition and alleviated condition of stenosed column after operation.We evaluated the effect of spinal decompression by comparing the function of spinal cord before and after the operation with the ASIA（America spinal injury association ASIA）Score.as well as pathological examination and microscopic observation on removed tissue during operation.Results：Except for 2 patients who suffered from long term severe paraplegia,other patients＇symptoms improved after operation by comparing with pre-operation condition,with 12 cases（accounting for 63.2%） improved evidently.MRI reexamination showed that OLF affected spinal canal stenosis alleviated obviously.Post-operation pathological microscopic observation manifested that vertebras were hardened and cartilaginification.Conclusion：Flurosis is an important cause of ossification of the ligamentum flavum in high fluoride areas,which may affect many segments of centrum in the whole spine.MRI can determine the disease of spinal marrow and provide basis for OLF pre-operation diagnosis,differential diagnosis,and post-operation evaluation.Spinal canal stenosis caused by fluorosis needs early diagnosis and early operation.Posterior total laminectomy is the best method for treatment of spinal canal disease.