周文超,张浩,陈元元,沈晓龙,刘洋,袁文

• 1:第二军医大学附属长征医院脊柱一科

摘要(Abstract)：

[目的]探讨颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)前路手术患者的骨化物椎管容积占比(3D)对预后的评估。[方法]回顾性分析2012年1月~2015年12月本院收治的39例颈椎OPLL行前路手术患者。术前、术后2个月、术后半年及末次随访均进行颈椎JOA评分(Japanese Orthopaedic Association Scores,JOA)17分法。将患者术前原始DICOM格式颈椎三维CT数据导入三维重建软件(MIMICS 17.0;Materialise,Leuven,Belgium),对骨化物和相应累及范围的椎管进行三维重建,测量并记录患者骨化物体积及其椎管占有率(3D)、骨化物椎管占位率(2D)。[结果]根据末次随访时JOA评分的改善率(improvement rate,IR)将患者分为2组:优组(IR≥75%,19例)和非优组(IR<75%,20例)。优组骨化物椎管容积占比(3D)为(6.85±1.55)%,非优组为(10.97±3.22)%,两组比较差异有统计学意义(t=5.047,P<0.001);优组椎管占位率(2D)为(40.80±9.78)%;非优组为(52.77±14.54)%,两组比较差异有统计学意义(t=2.999,P=0.005)。骨化物椎管容积占比(3D)与JOA评分改善率具有明显负相关性(r=-0.789,P<0.001);而椎管占位率(2D)则与JOA评分改善率无相关性(r=-0.030,P=0.800)。[结论]前路治疗后纵韧带骨化症的疗效确切,骨化物椎管容积占比(3D)可以用于评估颈椎后纵韧带骨化症前路手术患者的预后,比传统的椎管占位率(2D)具有明显的优越性。

关键词(KeyWords)： 颈椎后纵韧带骨化症;三维椎管占有率;前路手术;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 周文超,张浩,陈元元,沈晓龙,刘洋,袁文

参考文献(References)：

• [1]An HS,Al-Shihabi L,Kurd M.Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine[J].J Am Acad Orthop Surg,2014,22(7):420-429.
• [2]Kudo H,Yokoyama T,Tsushima E,et al.Interobserver and intraobserver reliability of the classification and diagnosis for ossification of the posterior longitudinal ligament of the cervical spine[J].Eur Spine J,2013,22(1):205-210.
• [3]Chen Y,Chen D,Wang X,et al.Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine[J].Int Orthop,2009,33(2):477-482.
• [4]Abiola R,Rubery P,Mesfin A.Ossification of the posterior longitudinal ligament:etiology,diagnosis,and outcomes of nonoperative and operative management[J].Global Spine J,2016,6(2):195-204.
• [5]刘晓伟,陈德玉,王新伟,等.颈椎后纵韧带骨化症患者K线对两种颈后路手术疗效的影响[J].中国脊柱脊髓杂志,2013,23(1):6-10.
• [6]Iwasaki M,Okuda S,Miyauchi A,et al.Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament:Part 1:clinical results and limitations of laminoplasty[J].Spine(Phila Pa 1976),2007,32(6):647-653.
• [7]Chen Y,Guo Y,Lu X,et al.Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine[J].Spinal Disord Tech,2011,24(1):24-30.
• [8]Tani T,Ushida T,Ishida K,et al.Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament[J].Spine,2002,27(22):2491-2498.
• [9]Sugrue PA,Mc CJ,Halpin RJ,et al.Surgical management of cervical ossification of the posterior longitudinal ligament:natural history and the role of surgical decompression and stabilization[J].Neurosurg Focus,2011,30(3):3.
• [10]Chen Y,Yang L,Liu Y,et al.Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament[J].PLo S One,2014,9(7):e102008.
• [11]Odate S,Shikata J,Kimura H,et al.Anterior corpectomy with fusion in combination with an anterior cervical plate in the management of ossification of the posterior longitudinal ligament[J].J Spinal Disord Tech,2012,25(3):133-137.
• [12]邱锋,马向阳,杨进城.应用Mimics测量脊髓容积[J].中国脊柱脊髓杂志,2013,23(11):1043-1045.
• [13]Lee N,Yeul JG,Shin HC,et al.Usefulness of 3-dimensional measurement of ossification of the posterior longitudinal ligament(OPLL)in patients with OPLL-induced myelopathy[J].Spine(Phila Pa 1976),2015,40(19):1479-1486.
• [14]Matsunaga S,Nakamura K,Seichi A,et al.Radiographic predictors for the development of myelopathy in patients with ossification of the posterior longitudinal ligament:a multicenter cohort study[J].Spine(Phila Pa 1976),2008,33(24):2648-2650.
• [15]Inamasu J,Guiot BH.Factors predictive of surgical outcome for ossification of the posterior longitudinal ligament of the cervical spine[J].J Neurosurg Sci,2009,53(3):93-100.
• [16]Mochizuki M,Aiba A,Hashimoto M,et al.Cervical myelopathy in patients with ossification of the posterior longitudinal ligament[J].J Neurosurg Spine,2009,10(2):122-128.
• [17]Izumi T,Hirano T,Watanabe K,et al.Three-dimensional evaluation of volume change in ossification of the posterior longitudinal ligament of the cervical spine using computed tomography[J].Eur Spine J,2013,22(11):2569-2574.
• [18]Fujimori T,Iwasaki M,Nagamoto Y,et al.Three-dimensional measurement of growth of ossification of the posterior longitudinal ligament[J].J Neurosurg Spine,2012,16(3):289-295.