后路椎板减压内固定术治疗胸椎黄韧带骨化症的预后因素

发布时间：2018-06-08 05:53

  本文选题：椎板减压 + 内固定　； 参考：《中国矫形外科杂志》2017年13期

【摘要】：[目的]研究胸椎黄韧带骨化症(ossification of ligamentum flavum,OLF)采用后路椎板减压内固定术治疗的疗效及预后影响因素。[方法]对2012年1月~2015年10月经手术治疗且完整随访的51例胸椎OLF患者资料进行回顾性分析,对可能影响患者预后的因素,如性别、年龄、病程、术前及术后日本骨科协会(JOA)评分、椎管面积残余率、T2加权像髓内高信号、术前是否存在二便功能障碍、术后是否存在脑脊液漏等因素进行χ2检验和Logistic回归统计分析。[结果]根据术后JOA评分改善率分为优良组(JOA改善率≥25%,38例)和不良组(JOA改善率25%,13例),术后恢复优良率74.51%。两组间年龄、术前JOA评分及病程等患者一般资料差异无统计学意义(P0.05),在T2加权像髓内高信号(P=0.004)、椎管面积残余率(P=0.009)及术前存在二便功能障碍(P=0.002)等方面差异具有统计学意义;Logistic回归分析发现病变T2加权像髓内高信号(OR=6.202)、椎管面积残余率(OR=13.286)及术前存在二便功能障碍(OR=25.905)与预后影响关系密切。[结论]后路椎板减压内固定手术治疗胸椎OLF效果良好,患者术前存在T2加权像髓内高信号、椎管面积残余率≤80%、二便功能障碍提示预后不良。
[Abstract]:[objective] to study the curative effect and prognostic factors of ossification of ligamentum flavum ossification of thoracic vertebrae treated by posterior laminectomy and internal fixation. [methods] the data of 51 patients with OLF of thoracic vertebra from January 2012 to October 2015 were analyzed retrospectively. The prognostic factors, such as sex, age, course of disease, were analyzed retrospectively. Preoperative and postoperative Japanese orthopedic association (JOAA) score, spinal canal area residual rate (T2-weighted) and intramedullary hyperintensity (T2-weighted) were analyzed by 蠂 2 test and Logistic regression. [results] according to the improvement rate of JOA score after operation, the improvement rate of JOA was divided into good group (n = 38) and bad group (n = 25). The improvement rate of JOA was 25 cases and the recovery rate was 74.51%. Between the two groups, There was no significant difference in preoperative JOA score and course of disease (P 0.05). The difference was statistically significant in T2 weighted imaging of intramedullary hyperintensity and residual rate of spinal canal area (P0. 009) and preoperative presence of 2 stool dysfunction (P0. 002). It was found that there was a close relationship between the lesion and the prognosis of patients with intramedullary hyperintensity, residual area of vertebral canal (OR13.286) and the presence of pre-operative dysfunction of defecation (OR25.905) on T 2-weighted images. [conclusion] posterior laminar decompression and internal fixation were effective in the treatment of thoracic OLF. The patients had high signal intensity in T 2 weighted imaging before operation, residual rate of vertebral canal area 鈮，

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