胸椎黄韧带骨化症课件.pptx

1、l贺石生贺石生 侯铁胜侯铁胜 赵杰赵杰l胸椎黄韧带附着处骨化是比较常见的现胸椎黄韧带附着处骨化是比较常见的现象，但引起脊髓压迫，导致胸椎黄韧带象，但引起脊髓压迫，导致胸椎黄韧带骨化症比较少见骨化症比较少见lWilliams回顾了回顾了50例尸体标本及例尸体标本及100个个CT扫描，发扫描，发现韧带附着处骨化比较常见。现韧带附着处骨化比较常见。lRadiology.1984 Feb;150(2):423-6.lMaigne 对对121例老年人调查发现下胸椎例老年人调查发现下胸椎83%附着点骨化，腰椎附着点骨化，腰椎33%骨化，认为下胸椎尾骨化，认为下胸椎尾端附着处骨化是老年人的一种正常现象，受端

2、附着处骨化是老年人的一种正常现象，受旋转应力的影响旋转应力的影响lSurg Radiol Anat.1992;14(2):119-24.lPayer M,et al.Thoracic myelopathy due to enlarged ossified yellow Ligaments.J Neurosurg(Spine 1)92:105108,2000lMiyakoshi N,Shimada Y,Suzuki T.Factors related to long-term outcome after decompressive surgery for ossification of the

3、ligamentum flavum of the thoracic spine.J Neurosurg(Spine).99(3):251-6,2003.SymptomsNumbersWeakness in lower limbs and gait disturbance25Numbness and Sensory deficit24Low back pain13Squeezing tight band around chest or abdomen10Neurological claudication 9Leg pain7Fecal and urinary incontinence11Knee

4、 and ankle hyperreflexia22Positive patellar and ankle clonus13Positive Babinksi14Location of OLFNumbersT10-T118T11-T128T8-T113T6-T102T10-T122T1-T3,T11-T121T1-T71T1-T31T2-T31颈、胸、腰椎均可出现，颈椎少见，而以胸椎和胸腰椎多见颈、胸、腰椎均可出现，颈椎少见，而以胸椎和胸腰椎多见根据其形态可进行根据其形态可进行X线分型，线分型，(1)棘突型；棘突型；又可分为上位型，又可分为上位型，下位型和上下位型；下位型和上下位型；(2)板状

5、型；板状型；(3)结节状型；结节状型；(4)游离型。游离型。lThe lateral-type lesion showed ossification only at the facet joint capsulelThe extended type showed ossification extending to the laminalThe enlarged type showed thickened ossification with anteromedial enlargementlThe fused type showed thickened bilateral ossified li

6、gaments fused at the midline lThe tuberous type showed fused ossified ligaments growing anteriorlylThe more advanced the ossified ligamentum flavum from the lateral to the tuberous type,the more stenotic the spinal canal becomes.l可分为三种类型（可分为三种类型（MRI矢状位扫描）矢状位扫描）l局灶型：骨化局限在两个节段问l连续型：骨化连续三个节段及以上的l跳跃型：局灶

7、或连续OLF间断地分布在各 段胸椎，之间为无骨化的节段31 casesShiokawa K,et al.Clinical analysis and prognostic study of ossifiedligamentum flavum of the thoracic spine.J Neurosurg(Spine 2)94:221226,2001Ca se NoSexAge(yrs)OLFCoexisting DiseasesSurgical Procedures1M46T10-11L3-5 canal stenosis,T10/11 disc herniationT10-11 lamim

8、ectomy,L3-5 laminectomy2M56T11-12C2-3 OPLL,T3-5 OPLLT11-12 laminectomy3F64T10-11C4/5 disc herniation,T4-6 OPLLT10-T11 laminectomy,T4-6 OPLL removal4M42T8-11T9/10 disc herniationT8-11 laminectomy,T9/10 discectomy5F67T11-12C3-6 canal stenosis,T11/12 disc herniationT11-12,C3-6 laminectomy6M63T6-10C2-7

9、OPLL,T6-8 OPLLT6-10 laminectomy,T6-8 OPLL removal7M70T11-12L4/5 disc herniationT11-12 laminectomy8F44T1-3C4/5,C5/6,T1/2,T2/3 ossified disc herniationT1-3 laminectomy,T1/2,2/3 discectomy9F71T8-11L4/5 canal stenosisT8-11,L4-5 lamnectomy10M52T10-12T10/11,11/12 disc herniationT10-12 laminectomy11M47T1-7

10、C3-5 canal stenosis;C2-4 OPLLC3-5,T1-7 laminectomy12M59T1-3,T11-12T9/10 disc herniation,L4/5 stenosisT1-3,T11-12 laminectomy13M69T10-12T10/11 disc herniation,C3-6 canal stenosis T10-12 laminectomy,C3-6 laminectomy14M55T10-11T8/9 disc herniation,L4/5 disc herniationT10-11 laminectomy15F61T6-10C3-6 OP

11、LL,L4-5 canal stenosisT6-10 laminectomy16M64T8-11C5/6 disc herniationT8-11 laminectomylMiyakoshi N,Shimada Y,Suzuki T.Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine.J Neurosurg(Spine).99(3):251-6,2003.lFFO:Final follow

12、 up outcome;RR:Recovery rate l*:Significant differencel:OLF Type was scored from small to large as:1,lateral;2,extended;3,enlarged;4,fused;and 5,tuberous VariablesJOA Score at FFORR at FFOCoefficientp ValueCoefficientp ValueAge(yrs)-0.6300.120-0.5340.404Preoperative Symptom Duration (Months)-0.2060.

13、003*-2.4920.001*Preoperative JOA Score1.1740.021*1.5490.040*Levels of OFL-0.5870.375-2.0380.674OFL Type-0.5710.088-3.6510.346lThe surgical outcomes classified as Excellent:Nurick Scale Grades 0-2 and JOA improvement more than 1;Fair:Nurick Scale Grades 3-5 or JOA no improvement.Sex:female=0,male=1 T

14、he other variables:without=0,with=1 The surgical outcome:Excellent=0,Fair=1.OR:Odds Ratio *:Significant differenceVariablesp ValueORSex0.3471.024Coexisting Spinal Diseases0.0921.251Operation for Coexisting Spinal Diseases0.1031.136Intramedullary High T2 Signal Change0.038*1.478Weakness in Lower Extr

15、emities and Gait Disturbance0.3511.269Numbness and Sensory Deficit0.1741.172Low back pain0.5731.042Squeezing Tight Band Around Chest or Abdomen0.3781.329Neurological Claudication 0.2721.196Leg Pain0.7251.182Fecal and/or Urinary Incontinence0.002*3.274Knee and/or Ankle Hyperreflexia0.2171.312Positive

16、 Patellar and/or Ankle Clonus0.016*2.531Positive Babinksi Sign0.0792.137p 经常不断地学习,你就什么都知道。你知道得越多,你就越有力量p Study Constantly,And You Will Know Everything.The More You Know,The More Powerful You Will Be学习总结结束语当你尽了自己的最大努力时，失败也是伟大的，所以不要放弃，坚持就是正确的。When You Do Your Best,Failure Is Great,So DonT Give Up,Stick To The End演讲人：XXXXXX 时 间：XX年XX月XX日