揭盖法治疗胸椎黄韧带骨化症的预后分析
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摘要
目的探索揭盖法治疗胸椎黄韧带骨化症预后的影响因素分析。方法选取诊断为单节段胸椎黄韧带骨化症于笔者医院手术治疗的患者共71例,记录其病程、血压、血脂、丙氨酸氨基转移酶、血肌酐,年龄、性别、体重指数、术前JOA评分、手术节段、椎管面积残余率、T_2WI髓内高信号、脊髓受压分度、CT矢状位椎管前后径残余率、CT横断面椎管前后径残余率(中央)、CT横断面椎管前后径残余率(侧界)、CT横断面椎管前后径残余率(旁正中)。同时对患者进行随访,在随访期间发生不良预后的患者定义为不良预后组,病情无恶化者定义为预后良好组,分析影响患者预后的因素;运用ROC曲线分析较大危险因素对预测患者预后风险的敏感度和特异性。结果 71例患者中,失访6例,预后良好为52例; 13例发生终点事件,此为预后不良组。多因素COX回归结果显示CT横断面椎管前后径残余率(旁正中)以及椎管面积残余率对患者预后有显著影响;两者比较,前者较椎管面积残余率的影响程度高(RR=3. 547、2. 324); ROC曲线下CT横断面椎管前后径残余率(旁正中)的AUC为0. 810(95%CI:0. 699～0. 922),其敏感度和特异性分别为63. 5%、83. 3%。结论揭盖法治疗胸椎黄韧带骨化患者的效果较好,CT横断面椎管前后径残余率(旁正中)对胸椎黄韧带骨化患者预后风险率的大小有较好的预测能力,有望作为相应患者的常规评估指标广泛应用于临床。
Objective To investigate the prognosis factors of the thoracic ossification of Ligament Flavum by decompression of vertebral canal. Methods A total of 71 patients were diagnosed as thoracic ossification of ligament flavum in our hospital, and their course of disease, blood pressure, blood lipid,glutamic pyruvic transaminase, serum creatinine,age,sex,body mass index, JOA score,image type,operative segment, spinal canal area residual rate, T2 WI intramedullary high signal, spinal compression grading, canal diameter occupying ratio on sagittal CT, Canal diameter occupying ratio on axial CT(midline),canal diameter occupying ratio on axial CT(boundary),canal diameter occupying ratio on axial CT(paramedian) were recorded. All patients with adverse outcomes were defined as the poor prognosis group during the follow-up period. The patients with positive outcomes were defined as the good prognosis group. We analyzed the factors that affect the prognosis of patients and the sensitivity and specificity in the larger risk factors of patients according to the receiver operating characteristic curve. Results Among the 71 patients, 6 patients were lost to follow-up. The number of good prognosis was52 and the number of good prognosis was 13. COX's proportional harzard model showed that patients with canal diameter occupying ratio on axial CT(paramedian) and spinal canal area residual rate had significant influence on the prognosis of the patients. The Canal diameter occupying ratio on axial CT(paramedian) and spinal canal area residual rate had the highest influence(RR = 3. 547,2. 324). The area curves of JOA score was 0. 810,(95% CI:0. 699-0. 922), and their sensitivity and specificity were 63. 5%,83. 3%. Conclusion The treatment of decompression of vertebral canal on the thoracic ossification of ligament flavum is better and canal diameter occupying ratio on axial CT(paramedian) has good predictive ability for the prognosis which is expected to be one of the routine indexes for patients and wide speard.
Objective To investigate the prognosis factors of the thoracic ossification of Ligament Flavum by decompression of vertebral canal. Methods A total of 71 patients were diagnosed as thoracic ossification of ligament flavum in our hospital, and their course of disease, blood pressure, blood lipid,glutamic pyruvic transaminase, serum creatinine,age,sex,body mass index, JOA score,image type,operative segment, spinal canal area residual rate, T2 WI intramedullary high signal, spinal compression grading, canal diameter occupying ratio on sagittal CT, Canal diameter occupying ratio on axial CT(midline),canal diameter occupying ratio on axial CT(boundary),canal diameter occupying ratio on axial CT(paramedian) were recorded. All patients with adverse outcomes were defined as the poor prognosis group during the follow-up period. The patients with positive outcomes were defined as the good prognosis group. We analyzed the factors that affect the prognosis of patients and the sensitivity and specificity in the larger risk factors of patients according to the receiver operating characteristic curve. Results Among the 71 patients, 6 patients were lost to follow-up. The number of good prognosis was52 and the number of good prognosis was 13. COX's proportional harzard model showed that patients with canal diameter occupying ratio on axial CT(paramedian) and spinal canal area residual rate had significant influence on the prognosis of the patients. The Canal diameter occupying ratio on axial CT(paramedian) and spinal canal area residual rate had the highest influence(RR = 3. 547,2. 324). The area curves of JOA score was 0. 810,(95% CI:0. 699-0. 922), and their sensitivity and specificity were 63. 5%,83. 3%. Conclusion The treatment of decompression of vertebral canal on the thoracic ossification of ligament flavum is better and canal diameter occupying ratio on axial CT(paramedian) has good predictive ability for the prognosis which is expected to be one of the routine indexes for patients and wide speard.
引文
1王少锋,魏运栋,吴占勇,等.胸椎黄韧带骨化症的手术疗效及影响因素分析[J].临床骨科杂志,2016, 19(3):279-282
2宁尚龙,陈仲强,马信龙,等.胸椎黄韧带骨化基础与临床研究进展[J].中国矫形外科杂志,2017, 25(11):999-1004
3赵为公,毛根稳,韩学哲,等.薄化揭盖法治疗胸椎黄韧带骨化症的疗效观察[J].西安交通大学学报:医学版,2016(2):170-173
4 Feng F,Sun C, Chen Z. A diagnostic study of thoracic myelopathy due to ossification of ligamentum flavum[J]. Eur Spine J, 2015,24(5):947-954
5 Li Z,Ren D,Zhao Y, et al. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum:a retrospective analysis of 85 cases[J]. Spinal Cord, 2016,54(3):188-196
6冯法博,孙垂国,陈仲强,等.胸椎黄韧带骨化症临床特点及定位诊断进展[J].中华骨科杂志,2015,35(1):83-90
7冯法博,孙垂国,陈仲强,等.“揭盖式”胸椎管后壁切除术治疗单节段胸椎黄初带骨化症的疗效及其影响因素[J].中国脊柱脊髓杂志,2014,7:585-592
8潘伟,孙垂国,陈仲强.胸椎管狭窄症手术治疗研究进展[J].中国煤炭工业医学杂志,2016,6:939-943
9郭娟.后路椎板减压术治疗胸椎黄韧带骨化症的术中配合护理[J].实用临床医药杂志,2016, 20(20):182-183
10潘宇,陈其昕.全椎板切除术治疗胸椎黄韧带骨化的手术疗效分析[J].浙江临床医学,2017, 19(8):1489-1490
11王晓东,闫宏伟,郝定均,等.胸椎黄韧带骨化症的临床特点及外科治疗[J].陕西医学杂志,2014,43(6):713-714
12 Liu FJ,Chai Y,Shen Y, et al. Posterior decompression with transforaminal interbody fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament and the ligamentum flavum at the same level.[J]. J Clin Neurosci, 2013, 20(4):570-575
13宁尚龙,陈仲强,马信龙,等.胸椎黄韧带骨化基础与临床研究进展[J].中国矫形外科杂志,2017,25(11):999-1004
14 Gao R, Yuan W,Yang L,et al. Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum[J]. Spine J,2013,13(9):1032-1038
15 Eun SS,Kumar R, Choi WG, et al. Lamina fenestration technique for treatment of thoracic ossified ligamentum flavum:2-year followup result[J]. J Neurol Surg Part A Central Eur Neurosurg, 2016, 78(3):286-290
16贺宝荣,许正伟,郝定均,等.胸椎黄韧带骨化症患者髓内MRI高信号与手术疗效的关系[J].中国脊柱脊髓杂志,2014,24(10):928-932
17魏富鑫,崔尚斌,刘少喻,等.局灶性胸椎黄韧带骨化症的诊治效果分析[J].脊柱外科杂志,2012, 10(4):211-214
18 Sun TW,Zhang LL,Zhang H,et al. The analysis of prognostic factors in patients with thoracic ossification of the ligamentum flavum and thoracic ossification of posterior longitudinal ligament by posterior decompression[J]. Zhonghua Waike Zazhi, 2012, 50(12):1076-1081
19王国庆,胡涌亮,蒋曙,等.前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响[J].中国医药,2017,1:114-117
20零刚新,阮兵,古文熠.硬膜囊与椎管的面积之比的CT测量指标在椎管狭窄症的诊断价值研究[J].现代医用影像学,2016,25(2):170-173
2宁尚龙,陈仲强,马信龙,等.胸椎黄韧带骨化基础与临床研究进展[J].中国矫形外科杂志,2017, 25(11):999-1004
3赵为公,毛根稳,韩学哲,等.薄化揭盖法治疗胸椎黄韧带骨化症的疗效观察[J].西安交通大学学报:医学版,2016(2):170-173
4 Feng F,Sun C, Chen Z. A diagnostic study of thoracic myelopathy due to ossification of ligamentum flavum[J]. Eur Spine J, 2015,24(5):947-954
5 Li Z,Ren D,Zhao Y, et al. Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum:a retrospective analysis of 85 cases[J]. Spinal Cord, 2016,54(3):188-196
6冯法博,孙垂国,陈仲强,等.胸椎黄韧带骨化症临床特点及定位诊断进展[J].中华骨科杂志,2015,35(1):83-90
7冯法博,孙垂国,陈仲强,等.“揭盖式”胸椎管后壁切除术治疗单节段胸椎黄初带骨化症的疗效及其影响因素[J].中国脊柱脊髓杂志,2014,7:585-592
8潘伟,孙垂国,陈仲强.胸椎管狭窄症手术治疗研究进展[J].中国煤炭工业医学杂志,2016,6:939-943
9郭娟.后路椎板减压术治疗胸椎黄韧带骨化症的术中配合护理[J].实用临床医药杂志,2016, 20(20):182-183
10潘宇,陈其昕.全椎板切除术治疗胸椎黄韧带骨化的手术疗效分析[J].浙江临床医学,2017, 19(8):1489-1490
11王晓东,闫宏伟,郝定均,等.胸椎黄韧带骨化症的临床特点及外科治疗[J].陕西医学杂志,2014,43(6):713-714
12 Liu FJ,Chai Y,Shen Y, et al. Posterior decompression with transforaminal interbody fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament and the ligamentum flavum at the same level.[J]. J Clin Neurosci, 2013, 20(4):570-575
13宁尚龙,陈仲强,马信龙,等.胸椎黄韧带骨化基础与临床研究进展[J].中国矫形外科杂志,2017,25(11):999-1004
14 Gao R, Yuan W,Yang L,et al. Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum[J]. Spine J,2013,13(9):1032-1038
15 Eun SS,Kumar R, Choi WG, et al. Lamina fenestration technique for treatment of thoracic ossified ligamentum flavum:2-year followup result[J]. J Neurol Surg Part A Central Eur Neurosurg, 2016, 78(3):286-290
16贺宝荣,许正伟,郝定均,等.胸椎黄韧带骨化症患者髓内MRI高信号与手术疗效的关系[J].中国脊柱脊髓杂志,2014,24(10):928-932
17魏富鑫,崔尚斌,刘少喻,等.局灶性胸椎黄韧带骨化症的诊治效果分析[J].脊柱外科杂志,2012, 10(4):211-214
18 Sun TW,Zhang LL,Zhang H,et al. The analysis of prognostic factors in patients with thoracic ossification of the ligamentum flavum and thoracic ossification of posterior longitudinal ligament by posterior decompression[J]. Zhonghua Waike Zazhi, 2012, 50(12):1076-1081
19王国庆,胡涌亮,蒋曙,等.前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响[J].中国医药,2017,1:114-117
20零刚新,阮兵,古文熠.硬膜囊与椎管的面积之比的CT测量指标在椎管狭窄症的诊断价值研究[J].现代医用影像学,2016,25(2):170-173