胸椎黃韌帶骨化癥課件

1、賀石生賀石生 侯鐵勝侯鐵勝 趙杰趙杰胸椎黃韌帶附著處骨化是比較常見(jiàn)的現(xiàn)胸椎黃韌帶附著處骨化是比較常見(jiàn)的現(xiàn)象，但引起脊髓壓迫，導(dǎo)致胸椎黃韌帶象，但引起脊髓壓迫，導(dǎo)致胸椎黃韌帶骨化癥比較少見(jiàn)骨化癥比較少見(jiàn)Williams回顧了回顧了50例尸體標(biāo)本及例尸體標(biāo)本及100個(gè)個(gè)CT掃描，發(fā)現(xiàn)掃描，發(fā)現(xiàn)韌帶附著處骨化比較常見(jiàn)。韌帶附著處骨化比較常見(jiàn)。Radiology. 1984 Feb;150(2):423-6.Maigne 對(duì)對(duì)121例老年人調(diào)查發(fā)現(xiàn)下胸椎例老年人調(diào)查發(fā)現(xiàn)下胸椎83%附附著點(diǎn)骨化，腰椎著點(diǎn)骨化，腰椎33%骨化，認(rèn)為下胸椎尾端附骨化，認(rèn)為下胸椎尾端附著處骨化是老年人的一種正常現(xiàn)象，受旋轉(zhuǎn)應(yīng)

2、著處骨化是老年人的一種正?，F(xiàn)象，受旋轉(zhuǎn)應(yīng)力的影響力的影響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頸、胸、腰椎均可出現(xiàn)，頸椎少見(jiàn)，而以胸椎和胸腰椎多見(jiàn)頸、胸、腰椎均可出現(xiàn)，頸椎少見(jiàn)，而以胸椎和胸腰椎多見(jiàn)根據(jù)其形態(tài)可進(jìn)行根據(jù)其形態(tài)可進(jìn)行X線分型，線分型， (1)棘突型；棘突型； 又可分為上位型，又可分為上位型， 下位型和上下位型；下位型和

5、上下位型；(2)板狀型；板狀型；(3)結(jié)節(jié)狀型；結(jié)節(jié)狀型；(4)游離型。游離型。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.可分為三種類型（可分為三種類型（MRI矢狀位掃描）矢狀位掃描）局灶型：骨化局限在兩個(gè)節(jié)段問(wèn)連續(xù)型：骨化連續(xù)三個(gè)節(jié)段及以上的跳躍型：局

7、灶或連續(xù)OLF間斷地分布在各 段胸椎，之間為無(wú)骨化的節(jié)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