Markiewitz A D, Boumphrey F R, Bauer T W, Bell G R
81st Medical Squadron (AETC), Keesler Air Force Base Mississippi, USA.
Spine (Phila Pa 1976). 1996 Feb 15;21(4):506-11. doi: 10.1097/00007632-199602150-00019.
This study measured the incidence of calcium pyrophosphate dihydrate crystal deposition in specimens of ligamenta flava in consecutive patients undergoing decompressive laminectomy between 1984 and 1991. The results were compared to determine the difference between calcium pyrophosphate dihydrate-negative patients with lumbar canal spinal stenosis.
The results were compared with cadaver specimens and literature values to determine if calcium pyrophosphate dihydrate crystal deposition disease contributes to the thickening of the ligamentum flavum and thereby contributes to spinal stenosis.
Calcium pyrophosphate dihydrate crystal deposition disease has been described in the axial skeleton. Hypertrophy of the ligamentum flavum has been suggested to contribute to stenosis. The association of calcium pyrophosphate dihydrate disease and hypertrophied ligamenta flava has not been fully defined nor linked to neurologic symptoms and signs.
The incidence of calcium pyrophosphate dihydrate crystal deposition in specimens of ligamenta flava obtained from four groups was measured: specimens obtained during surgery from 102 consecutive patients undergoing decompression laminectomy between 1984 and 1991, 47 additional pathologic specimens of ligamentum flavum tested between 1984 and 1991, 222 calcium pyrophosphate dihydrate-positive Pathology Department specimens collected between 1980 and 1991, and, as control specimens from 20 cadavers. The associated patient histories were reviewed for the first two groups; no histories were available for the cadaver group.
The incidence of calcium pyrophosphate dihydrate crystal deposition was 24.5% in the ligamentum flavum among the surgical patients, 31% among the Pathology Department specimens, 33.8% among the calcium pyrophosphate dihydrate-positive Pathology Department specimens, and 5% among the cadavers. No associated medical conditions with calcium pyrophosphate dihydrate crystal deposition were found among the medical histories. Patients with the symptoms of spinal stenosis who were also calcium pyrophosphate dihydrate-negative patients with symptoms of less than 6 months' and less than 24 months' duration (P < 0.001). Except for time to presentation, calcium pyrophosphate dihydrate-negative patients had similar signs and symptoms of lumbar canal spinal stenosis. Having previous spine surgery did not produce a statistically significant risk of having calcium pyrophosphate dihydrate crystal deposition. No specific laboratory tests were found to be of predictive value.
These findings suggest that calcium pyrophosphate dihydrate crystal deposition may indeed be associated with the thickening of the ligamentum flavum, if so, patients may benefit from medical treatment before undergoing surgical treatment of lumbar canal spinal stenosis.
本研究测量了1984年至1991年间连续接受减压椎板切除术患者的黄韧带标本中焦磷酸钙二水合物晶体沉积的发生率。将结果进行比较，以确定焦磷酸钙二水合物阴性的腰椎管狭窄患者之间的差异。
将结果与尸体标本和文献值进行比较，以确定焦磷酸钙二水合物晶体沉积疾病是否导致黄韧带增厚，从而导致椎管狭窄。
焦磷酸钙二水合物晶体沉积疾病已在中轴骨骼中被描述。有人提出黄韧带肥大是导致狭窄的原因。焦磷酸钙二水合物疾病与肥厚的黄韧带之间的关联尚未完全明确，也未与神经症状和体征相关联。
测量了四组黄韧带标本中焦磷酸钙二水合物晶体沉积的发生率：1984年至1991年间连续102例接受减压椎板切除术患者手术中获取的标本；1984年至1991年间另外检测的47份黄韧带病理标本；1980年至1991年间收集的222份焦磷酸钙二水合物阳性病理科标本；以及作为对照的20具尸体的标本。回顾了前两组患者的相关病史；尸体组没有病史记录。
手术患者中黄韧带焦磷酸钙二水合物晶体沉积的发生率为24.5%，病理科标本中为31%，焦磷酸钙二水合物阳性病理科标本中为33.8%，尸体中为5%。病史中未发现与焦磷酸钙二水合物晶体沉积沉积沉积相关的医疗状况。椎管狭窄症状患者中焦磷酸钙二水合物阴性且症状持续时间小于6个月和小于24个月的患者（P<0.001）。除就诊时间外，焦磷酸钙二水合物阴性患者的腰椎管狭窄体征和症状相似。既往有脊柱手术史并未产生焦磷酸钙二水合物晶体沉积的统计学显著风险。未发现有预测价值的特定实验室检查。
这些发现表明焦磷酸钙二水合物晶体沉积可能确实与黄韧带增厚有关，如果是这样，患者在接受腰椎管狭窄手术治疗前可能从药物治疗中获益。
