摘要目的 研究胸椎黄韧带骨化症(OLF)合并后纵韧带骨化(OPLL)采用单纯后路减压手术治疗的预后影响因素.方法 对2006年1月至2010年6月经手术治疗且完整随访的83例胸椎OLF合并OPLL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、病变节段、胸椎OPLL骨化类型、胸椎后凸角度、前方胸椎OPLL程度、胸椎OLF减压节段数、术前是否存在二便功能障碍、术后是否存在脑脊液漏及是否合并颈腰椎疾患等因素进行x2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(58例)和不良组(25例),两组间年龄、术前JOA评分及病程等患者一般资料无统计学意义(P＞0.05).在病变节段(x2=6.290,P=0.043)、OPLL骨化类型(x2=5.361,P=0.021)和术前存在二便功能障碍(x2 =27.711,P=0.000)等方面差异具有统计学意义；Logistic回归分析发现病变位于上段胸椎(P=0.044)、OPLL鸟嘴型(P =0.023)及术前存在二便功能障碍(P =0.009)与预后影响关系密切.术后24例(28.9％)患者出现脑脊液漏,3例患者术后早期出现深部感染,2例患者术后神经功能恶化.结论 上胸段骨化症预后较好,但存在鸟嘴型OPLL、术前存在二便功能障碍的患者预后不良,跳跃性多节段骨化症及合并重度颈腰椎疾患是预后不良的影响因素.

abstractsObjective To investigate the prognostic factors for patients with thoracic ossification of the ligamentum flavum(OLF) and thoracic ossification of posterior longitudinal ligament(OPLL).Methods Clinical information of 83 patients suffering from thoracic OLF and OPLL was reviewed retrospectively from January 2006 to June 2010.The related factors such as gender,age,preoperative and postoperative Japanese Orthopedic Association (JOA) score,pathological segment,type of thoracic OPLL,degree of thoracic kyphosis,anteroposterior diameter of OPLL,range of circumferential decompression,cerebrospinal fluid leakage or not and dysfunction or not and carotid lumbar disorders or not were analyzed by Chi-square and Logistic regression.Results All cases were classified into desirable group (58 cases)and undesirable group (25 cases) based on the postoperative JOA score improvement rate.Comparison of physical characteristics between two groups of age,preoperative JOA and the course of the disease had not statistically significant (P ＞ 0.05).Two groups in pathological segment of thoracic OPLL(x2 =6.290,P =0.043),the ossification type of OPLL (x2 =5.361,P =0.021) and dysfunction or not in preoperative (x2 =27.711,P =0.000) had significant difference.Logistic regression analysis showed that the upper thoracic segments (P =0.044),beak type ossification (P =0.023) and with dysfunction in preoperative (P =0.009) were risk factors.There were 24 patients (28.9％) with cerebrospinal fluid leakage,3 patients with early postoperative deep infection and neurological deterioration of 2 cases in postoperative.Conclusions Patients with ossification on the upper section of thoracic have a better prognosis,but the beaked localized longitudinal ligament ossification in patients and associated with preoperative dysfunction show a poor prognosis,combined jumping segmental ossification and cervical or lumbar severe disorders are the influencing factor for poor prognosis.