Sun Tian-wei, Zhang Li-long, Zhang Hang, Lu Shou-liang, Yadav Sandip kumar
Department of Spine Surgery, Tianjin Union Medicine Centre, Tianjin, China.
Zhonghua Wai Ke Za Zhi. 2012 Dec;50(12):1076-81.
To investigate the prognostic factors for patients with thoracic ossification of the ligamentum flavum (OLF) and thoracic ossification of posterior longitudinal ligament (OPLL).
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.
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 (χ(2) = 6.290, P = 0.043), the ossification type of OPLL (χ(2) = 5.361, P = 0.021) and dysfunction or not in preoperative (χ(2) = 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.
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.
探讨胸椎黄韧带骨化（OLF）和胸椎后纵韧带骨化（OPLL）患者的预后因素。
回顾性分析2006年1月至2010年6月间83例胸椎OLF和OPLL患者的临床资料。采用卡方检验和Logistic回归分析性别、年龄、术前及术后日本骨科协会（JOA）评分、病变节段、胸椎OPLL类型、胸椎后凸程度、OPLL前后径、环周减压范围、有无脑脊液漏、有无功能障碍及有无颈腰椎疾病等相关因素。
根据术后JOA评分改善率，将所有病例分为良好组（58例）和不良组（25例）。两组在年龄、术前JOA评分及病程等身体特征方面比较，差异无统计学意义（P>0.05）。两组在胸椎OPLL病变节段（χ(2)=6.290，P=0.043）、OPLL骨化类型（χ(2)=5.361，P=0.021）及术前有无功能障碍（χ(2)=27.711，P=0.000）方面存在显著差异。Logistic回归分析显示，上胸椎节段（P=0.044）、喙型骨化（P=0.023）及术前有功能障碍（P=0.009）为危险因素。有24例患者（28.9%）发生脑脊液漏，3例术后早期发生深部感染，2例术后出现神经功能恶化。
胸椎上段骨化患者预后较好，但患者存在喙型局限性纵韧带骨化且伴有术前功能障碍者预后较差，合并跳跃节段骨化及颈腰椎严重疾病是预后不良的影响因素。
