|其他题名||Longterm outcome after the decompressive surgery for thoracic myelopathy due to the ossification of the ligamentum flavum
|孙垂国; 陈仲强; 刘忠军; 刘晓光; 齐强; 郭昭庆; 李危石; 曾岩
|摘要||目的 探讨胸椎黄韧带骨化症手术的远期疗效,分析其影响因素.方法 回顾性分析1990年1月至2005年12月确诊为胸椎黄韧带骨化症伴胸脊髓病接受手术治疗并获5年以上随访的44例患者资料,其中男性29例,女性15例；手术时年龄27 ～ 68岁,平均52岁.随访其术后2年及远期(5年以上)脊髓功能恢复情况,按改良的Epstein标准进行疗效分级,分析患者年龄、术前病程、手术节段和并发脑脊液漏等因素与术后远期疗效的相关性.结果 患者随访5～19年,平均随访8.5年.术后2年时的疗效优良率为77.3％ (34/44),末次随访时优良率为65.9％( 29/44)；除1例因急性外伤致截瘫患者术后恢复差之外,其余43例中术前病程＜12个月和≥12个月者的优良率分别为77.3％ (17/22)和57.1％(12/21),差异无统计学意义(P＞0.05)；手术节段限于T1～T9节段范围内患者和累及胸腰段(T10～L2)患者的优良率分别为78.9％ (15/19)和58.3％( 14/24),差异无统计学意义(P＞0.05).7例患者术后近期疗效优良而远期症状恶化,原因为未手术节段黄韧带骨化进一步生长4例,并发腰椎管狭窄症3例.结论 胸椎黄韧带骨化症术后近期疗效相对较好,但术后远期症状可能复发或加重；术前病程长或手术范围累及胸腰段者远期疗效可能较差；术后远期复发或加重的主要原因是未手术节段胸椎黄韧带骨化的生长及并发腰椎管狭窄症.
Objectives To investigate the long-term surgical outcome of thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) and evaluate the related risk factors.Methods Fortyfour patients who underwent decompressive laminectomy with thoracic OLF between January 1990 and December 2005 and got more than 5 years follow-up were retrospectively reviewed.Among these 44 cases,there were 29 male and 15 female whose ages at operation were 52 years averagefy (27-68 years).The 2-year follow-up results and long-term outcomes were classified according to the modified Epstein's standard,and then the rates of excellent or good (REG) were calculated.The correlation between the long-term REG and the patients' ages,durations of symptoms,decompressed levels,and dural leak were analyzed.Results The mean follow-up period of these 44 cases was 8.5 years(5-19 years).The REG at 2 years after laminectomy was 77.3％ (34/44),while the long-term REG was 65.9％ (29/44).There was one case who had suffered from an acute spinal cord injury got a poor post-operative outcome.The other 43 cases had chronic durations,including 22 cases whose pre-operative durations of symptoms were less than 12 months and 21 cases whose durations were equal to or more than 12 months.And the long-term REG of these two groups were 77.3 ％ ( 17/22 ) and 57.1％ ( 12/21 ) respectively ( P ＞ 0.05 ).The REG of those cases whose decompression levels were limited in T1-T9 was 78.9％ (15/19),while that of those cases whose laminectomy was relevant to thoracolumbar segment ( T10-L2 ) was 58.3％ (14/24) ( P ＞0.05 ).There were 7 cases who had excellent or good short-term results and poor long-term outcomes.The reasons of these changes included coexistence of lumbar spinal stenosis in three cases and the growth of the OLF at the adjacent levels in four cases.Conclusions Although the short-term results of the decompressive surgery for thoracic OLF is good,the regular long-term follow-up is necessary because the symptoms may reoccur or deteriorate secondary to lumbar spinal stenosis or the growth of OLF at the adjacent levels near former decompressive levels; the duration of symptoms which is more than one year and the decompression levels that is involved to T10-L2 segments are possibly related to the poor long-term outcomes.|
孙垂国,陈仲强,刘忠军,等. 胸椎黄韧带骨化症术后远期疗效分析[J]. 中华外科杂志,2012,50(5):426-429.
孙垂国,et al."胸椎黄韧带骨化症术后远期疗效分析".中华外科杂志 50.5(2012):426-429.
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