| 郝定均,贺宝荣,许正伟,郭华,王晓东,刘团江,郑永宏.胸椎后纵韧带骨化症术后临床疗效及其相关因素分析[J].脊柱外科杂志,2012,10(4):215-219. |
胸椎后纵韧带骨化症术后临床疗效及其相关因素分析  点此下载全文 (Fulltext) |
| 郝定均 贺宝荣 许正伟 郭华 王晓东 刘团江 郑永宏 |
| 410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科;410054 陕西, 西安交通大学附属红会医院脊柱外科 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2012.04.007 |
| 摘要点击次数: 1127 |
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| 摘要： |
| 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~2011年1月，本院收治胸椎后纵韧带骨化症患者64例，其中男39例，女25例，年龄为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36例，采用前路减压、植骨融合治疗12例，后外侧经关节突减压植骨融合9例，前后路联合减压植骨融合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。手术疗效采用日本骨科学会（Japanese Orthopaedic Association，JOA）评分及其改善率进行判定。结果 所有患者均获随访，随访时间为1～12年，平均4.6年。术前JOA评分为4.5±1.9分，末次随访时7.8±2.1分，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 T2加权像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%）患者术后合并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 T2加权像信号改变及是否合并糖尿病是影响手术疗效的主要因素。 |
| 关键词：胸椎 骨化，后纵韧带 截骨术 骨移植 减压术, 外科 脊柱融合术 |
| Outcomes and related factors of surgery for ossification of the posterior longitudinal ligament of the thoracic spine Fulltext |
| HAO Ding-jun HE Bao-rong XU Zheng-wei GUO Hua WANG Xiao-dong LIU Tuan-jiang ZHENG Yong-hong |
| Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China;Department of Spinal Surgery, Xi'an Red Cross Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
| Fund Project: |
| Abstract: |
| 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 factors significantly related to surgical outcomes. Methods The study included 64 patients (39 men and 25 women with a mean age of 54.1 years) who underwent fusion surgery for T-OPLL in our hospital from January 2000 to January 2011. Of all patients, 36 cases underwent posterior wide laminectomy, decompression and bone fusion; 12 cases underwent anterior decompression and bone fusion; 9 cases underwent decompression and bone fusion via postero-lateral approach;7 cases underwent combined anterior and posterior decompression and fusion. The relationship between surgical outcomes and clinical factors such as age, course of disease, radiological findings, classification, preoperative comorbidities, surgical methods, and complications were assessed. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score for thoracic myelopathy (11 points) and the recovery rate. Results All patient were followed up with the average time of 4.6 years (ranged 1 to 12 years). The JOA score was 4.5±1.9 points preoperatively and 7.8±2.1 points at the time of the final follow-up examination, with a recovery rate of (48.4±38.1)%. The recovery rate by surgical method was (37.6±36.8)% for posterior wide laminectomy, decompression, bone fusion, (62.9±32.6)% for anterior decompression and fusion via an anterior approach, (30.8±29.2)% for decompression and bone fusion via postero-lateral approach, and (59.5±39.1)% for combined anterior and posterior decompression and fusion. The outcome was relevant with age, course of disease, surgical methods, the signal changes on T2WI, and diabetes mellitus(P<0.05). One or more complications occurred in 30 patients (46.9%), including 17 cases with postoperative neurological deterioration, 12 cases with dural tears, 3 cases with epidural hematomas, and 5 cases with respiratory complications. Conclusion The outcomes of surgery for T-OPLL are favorable. The curative effect is relevant with age course of disease, surgical methods, signal changes on T2WI, and diabetes mellitus. |
| Keywords:Thoracic vertebrae Ossification of posterior longitudinal ligament Osteotomy Bone transplantation Decompression, surgical Spinal fusion |
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