Ando Kei, Imagama Shiro, Ito Zenya, Hirano Kenichi, Muramoto Akio, Kato Fumihiko, Yukawa Yasutsugu, Kawakami Noriaki, Sato Koji, Matsubara Yuji, Kanemura Tokumi, Matsuyama Yukihiro, Ishiguro Naoki
*Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Furo-cho, Chikusa-ku, Nagoya, Japan †Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya City, Japan ‡Department of Orthopedic Surgery, Meijo Hospital, Nagoya City, Japan §Department of Orthopedic Surgery, Nagoya 2nd Red Cross Hospital, Nagoya City, Japan ¶Department of Orthopedic Surgery, Kariya-Toyota General Hospital, Kariya City, Japan ‖Department of Orthopedic Surgery, Konan Kosei Hospital, Konan City, Japan; and **Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu City, Japan.
Spine (Phila Pa 1976). 2013 May 20;38(12):E748-54. doi: 10.1097/BRS.0b013e31828ff736.
Retrospective multi-institutional study.
The purpose of this study was to describe the surgical outcomes in patients with ossification of the ligamentum flavum (OLF) and determine the influence of an ossified anterior longitudinal ligament (OALL) on the clinical features and surgical outcomes in thoracic OLF.
Detailed analyses of surgical outcomes of thoracic OLF have been difficult because of rarity of this disease.
We identified 96 patients (77 males and 19 females with a mean age at surgery of 63.4 ± 10.3 yr) who underwent surgery for thoracic OLF and investigated their preoperative symptoms, severity of symptoms and myelopathy, disease duration, magnetic resonance imaging and computed tomographic findings, surgical procedure, intraoperative findings, and postoperative recoveries. The presence of OALL found at or near the most severely affected OLF level on sagittal computed tomographic images was classified into 1 of the following 4 types: (1) "no discernible type" (type N); (2) "one-sided type" (type O); (3) "discontinuous type" (type D); and (4) "continuous type" (type C). Multivariate logistic regression analysis was used to compute odds ratios and 95% confidence intervals to identify the risk factors associated with surgical outcomes.
The mean Japanese Orthopaedic Association score was 5.6 points preoperatively and 7.8 points 2 years postoperatively, yielding a mean recovery rate of 44.6%. Disease duration, presence of ossified dura mater, and type D OALL were the important factors for predicting surgical outcomes.
After evaluating surgical outcomes on the largest sample size of OLF surgical procedures thus far, our results show that disease duration, ossification of the dura mater, and the presence of type D OALL were risk factors related to surgical outcomes.
回顾性多机构研究。
本研究旨在描述黄韧带骨化（OLF）患者的手术结果，并确定胸段OLF中骨化的前纵韧带（OALL）对临床特征和手术结果的影响。
由于该疾病罕见，对胸段OLF手术结果进行详细分析一直很困难。
我们确定了96例接受胸段OLF手术的患者（77例男性和19例女性，手术时平均年龄为63.4±10.3岁），并调查了他们的术前症状、症状严重程度和脊髓病、病程、磁共振成像和计算机断层扫描结果、手术过程、术中发现以及术后恢复情况。矢状面计算机断层扫描图像上在最严重受累的OLF水平或其附近发现的OALL存在情况分为以下4种类型之一：（1）“不可辨认型”（N型）；（2）“单侧型”（O型）；（3）“间断型”（D型）；（4）“连续型”（C型）。采用多因素逻辑回归分析计算比值比和95%置信区间，以确定与手术结果相关的危险因素。
术前日本矫形外科学会平均评分为5.6分，术后2年为7.8分，平均恢复率为44.6%。病程、硬脑膜骨化的存在以及D型OALL是预测手术结果的重要因素。
在评估了迄今为止最大样本量的OLF手术的手术结果后，我们的结果表明病程、硬脑膜骨化以及D型OALL的存在是与手术结果相关的危险因素。
3级。
