Department of Orthopedics, Peking University Third Hospital, Beijing, China.
J Neurosurg Spine. 2011 Oct;15(4):386-92. doi: 10.3171/2011.5.SPINE10748. Epub 2011 Jul 1.
In this paper, the authors aimed to summarize the clinical characteristics of ossification of the ligamentum flavum (OLF) associated with dural ossification (DO) and to identify improved methods for preoperative diagnosis.
Thirty-six patients who had undergone OLF surgery between February 2005 and September 2009 were included in this retrospective study. The patients were divided into 2 groups: one that included patients with intraoperative evidence of DO and a second group that included patients without DO. The clinical features of DO were summarized and the neurological status of the patients was evaluated pre- and postoperatively.
The incidence rate of DO associated with OLF was 39% (14/36). The sensitivity and specificity of the tram track sign were found to be 93% and 59%, respectively. Dural ossification was found among 86% of the patients with tuberous type Sato classification. The postoperative neurological status of patients was generally improved relative to that observed prior to surgery, although neurological recovery did not differ between the 2 groups. Cerebrospinal fluid leakage was the main complication, occurring predominantly in the patients with DO, and all leaks resolved in all patients after comprehensive treatments.
The tram track sign and Sato classification were found to be useful for preoperative diagnosis of DO and for determining the surgical procedure to be performed. Dural ossification had no effect on postoperative neurological recovery.
总结黄韧带骨化（OLF）合并硬脊膜骨化（DO）的临床特点，寻找提高术前诊断水平的方法。
回顾性分析 2005 年 2 月至 2009 年 9 月因 OLF 手术治疗的 36 例患者的临床资料，根据术中是否发现 DO 将患者分为两组，总结 DO 的临床特点，并比较术前、术后神经功能变化。
合并 DO 的 OLF 发生率为 39%（14/36）。“铁轨征”的灵敏度和特异度分别为 93%和 59%。Sato 分类中结节型 DO 发生率为 86%。术后神经功能较术前均有不同程度的改善，但两组间神经功能恢复无明显差异。术后脑脊液漏是主要并发症，主要发生在合并 DO 的患者中，经综合治疗后所有患者漏口均愈合。
“铁轨征”和 Sato 分类有助于术前诊断 DO，并指导手术方式的选择。DO 对术后神经功能恢复无影响。
