胸椎黄韧带骨化症课件

1、贺石生贺石生 侯铁胜侯铁胜 赵杰赵杰胸椎黄韧带附着处骨化是比较常见的现胸椎黄韧带附着处骨化是比较常见的现象，但引起脊髓压迫，导致胸椎黄韧带象，但引起脊髓压迫，导致胸椎黄韧带骨化症比较少见骨化症比较少见Williams回顾了回顾了50例尸体标本及例尸体标本及100个个CT扫描，发现扫描，发现韧带附着处骨化比较常见。韧带附着处骨化比较常见。Radiology. 1984 Feb;150(2):423-6.Maigne 对对121例老年人调查发现下胸椎例老年人调查发现下胸椎83%附附着点骨化，腰椎着点骨化，腰椎33%骨化，认为下胸椎尾端附骨化，认为下胸椎尾端附着处骨化是老年人的一种正常现象，受旋转应

2、着处骨化是老年人的一种正常现象，受旋转应力的影响力的影响Surg Radiol Anat. 1992;14(2):119-24.Payer M,et al. Thoracic myelopathy due to enlarged ossified yellow Ligaments. J Neurosurg (Spine 1) 92:105108, 2000Miyakoshi N, Shimada Y, Suzuki T. Factors related to long-term outcome after decompressive surgery for ossification of th

3、e ligamentum flavum of the thoracic spine. J Neurosurg (Spine). 99(3):251-6, 2003.SymptomsNumbersWeakness in lower limbs and gait disturbance25Numbness and Sensory deficit24Low back pain13Squeezing tight band around chest or abdomen10Neurological claudication 9Leg pain7Fecal and urinary incontinence

4、11Knee and ankle hyperreflexia22Positive patellar and ankle clonus13Positive Babinksi14Location of OLFNumbersT10-T118T11-T128T8-T113T6-T102T10-T122T1-T3, T11-T121T1-T71T1-T31T2-T31颈、胸、腰椎均可出现，颈椎少见，而以胸椎和胸腰椎多见颈、胸、腰椎均可出现，颈椎少见，而以胸椎和胸腰椎多见根据其形态可进行根据其形态可进行X线分型，线分型， (1)棘突型；棘突型； 又可分为上位型，又可分为上位型， 下位型和上下位型；下位型和

5、上下位型；(2)板状型；板状型；(3)结节状型；结节状型；(4)游离型。游离型。The lateral-type lesion showed ossification only at the facet joint capsuleThe extended type showed ossification extending to the laminaThe enlarged type showed thickened ossification with anteromedial enlargementThe fused type showed thickened bilateral ossif

6、ied ligaments fused at the midline The tuberous type showed fused ossified ligaments growing anteriorlyThe more advanced the ossified ligamentum flavum from the lateral to the tuberous type, the more stenotic the spinal canal becomes.可分为三种类型（可分为三种类型（MRI矢状位扫描）矢状位扫描）局灶型：骨化局限在两个节段问连续型：骨化连续三个节段及以上的跳跃型：局

7、灶或连续OLF间断地分布在各 段胸椎，之间为无骨化的节段31 casesShiokawa K, et al. Clinical analysis and prognostic study of ossifiedligamentum flavum of the thoracic spine. J Neurosurg (Spine 2) 94:221226, 2001Ca se NoSexAge(yrs)OLFCoexisting DiseasesSurgical Procedures1M46T10-11L3-5 canal stenosis, T10/11 disc herniationT10-

8、11 lamimectomy, L3-5 laminectomy2M56T11-12C2-3 OPLL, T3-5 OPLLT11-12 laminectomy3F64T10-11C4/5 disc herniation, T4-6 OPLLT10-T11 laminectomy, T4-6 OPLL removal4M42T8-11T9/10 disc herniationT8-11 laminectomy, T9/10 discectomy5F67T11-12C3-6 canal stenosis, T11/12 disc herniationT11-12, C3-6 laminectom

9、y6M63T6-10C2-7 OPLL, T6-8 OPLLT6-10 laminectomy, T6-8 OPLL removal7M70T11-12L4/5 disc herniationT11-12 laminectomy8F44T1-3C4/5,C5/6,T1/2,T2/3 ossified disc herniationT1-3 laminectomy, T1/2,2/3 discectomy9F71T8-11L4/5 canal stenosisT8-11, L4-5 lamnectomy10M52T10-12T10/11,11/12 disc herniationT10-12 l

10、aminectomy11M47T1-7C3-5 canal stenosis; C2-4 OPLLC3-5, T1-7 laminectomy12M59T1-3, T11-12T9/10 disc herniation, L4/5 stenosisT1-3, T11-12 laminectomy13M69T10-12T10/11 disc herniation, C3-6 canal stenosis T10-12 laminectomy, C3-6 laminectomy14M55T10-11T8/9 disc herniation, L4/5 disc herniationT10-11 l

11、aminectomy15F61T6-10C3-6 OPLL, L4-5 canal stenosisT6-10 laminectomy16M64T8-11C5/6 disc herniationT8-11 laminectomyMiyakoshi N, Shimada Y, Suzuki T. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg (Spine). 9

12、9(3):251-6, 2003.FFO: Final follow up outcome; RR: Recovery rate *: Significant difference:OLF Type was scored from small to large as: 1, lateral; 2, extended; 3, enlarged; 4, fused; and 5, tuberous VariablesJOA Score at FFORR at FFOCoefficientp ValueCoefficientp ValueAge (yrs)-0.6300.120-0.5340.404

13、Preoperative Symptom Duration (Months)-0.2060.003*-2.4920.001*Preoperative JOA Score1.1740.021*1.5490.040*Levels of OFL-0.5870.375-2.0380.674OFL Type -0.5710.088-3.6510.346The surgical outcomes classified as Excellent: Nurick Scale Grades 0-2 and JOA improvement more than 1; Fair: Nurick Scale Grade

14、s 3-5 or JOA no improvement. Sex: female=0, male=1 The other variables: without=0, with=1 The surgical outcome: Excellent=0, Fair=1. OR: Odds Ratio *: Significant differenceVariablesp ValueORSex0.3471.024Coexisting Spinal Diseases0.0921.251Operation for Coexisting Spinal Diseases0.1031.136Intramedullary High T2 Signal Change0.038 * *1.478Weakness in Lower Extremities and Gait Disturbance0.3511.269Numbness and Sensory Deficit0.1741.172Low back pain0.5731.042Squeezing Tight Band Around Chest or Abdomen0.3