摘要
目的分析颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)患者椎管成形术后随访期间OPLL的CT影像学进展特征。方法回顾性分析2011年6月至2016年6月行颈椎后路单开门椎管成形术治疗21例OPLL患者的相关资料,男11例,女10例;年龄55-69岁,平均(61.48±4.29)岁。收集所有患者的性别,年龄,术前、术后及末次随访时日本矫形外科学会(Japanese Orthopaedic Association Scores,JOA)评分。通过术前及术后随访时的颈椎CT扫描及二维重建测量OPLL长度、宽度和厚度,计算平均进展速度,并分析术前OPLL大小与术后OPLL进展速度的关系。结果随访时间1.2-6.5年,平均(3.36±1.92)年。颈椎JOA评分手术前为(11.81±1.75)分,末次随访时为(14.43±1.69)分,差异有统计学意义(t=3.8,P<0.01)。术后OPLL的长度、宽度和厚度的平均进展速度分别为(3.54±2.89)mm/年、(0.49±0.52)mm/年和(0.34±0.21)mm/年。长度的平均进展速度与宽度、厚度比较,差异均有统计学意义(分别为t=3.6,P=0.003;t=3.8,P=0.002)。术后OPLL头端进展速度为(1.54±1.19)mm/年,尾端进展速度为(1.60±1.33)mm/年,两者差异无统计学意义(t=0.1,P=0.559)。线性回归分析显示OPLL长度进展速度与术前长度有相关性(OPLL长度进展速度(mm)=0.05×术前长度+1.23,R2=0.26,P=0.02);而OPLL宽度和厚度的进展速度与术前OPLL宽度和厚度无相关性。局灶型OPLL术后进展速度为(3.02±0.26)mm/年,节段型OPLL进展速度为(2.97±0.65)mm/年,连续型OPLL进展速度为(3.65±1.14)mm/年,混合型OPLL进展速度为(3.82±1.27)mm/年,其中任意两种类型OPLL术后进展速度的差异均无统计学意义。结论颈椎OPLL后路单开门椎管成形术后CT影像学随访显示OPLL长度、宽度和厚度均有进展,其中长度的进展速度较宽度和厚度更快,但OPLL头、尾端的进展速度无差异;OPLL长度的进展速度与术前OPLL长度呈正相关性。混合型及连续型OPLL的术后进展速度可能大于节段型及局限型的OPLL。
ObjectiveTo evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior lon-gitudinal ligament (OPLL) of the cervical spine. MethodsFrom June 2011 to June 2016, Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty. There were 21 patients finally enrolled in this study, which consisted of 11 male and 10 female aging from 55-69, mean(61.48±4.29). The preoperative patients all had severe symp-toms of spinal compression. Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender, age, pre-operative and postoperative follow-up.The length, width and thickness of OPLL were measured by CT scan and two-dimensional re-construction of cervical spine during preoperative and follow-up, and the average progress rate was calculated. The relationship be-tween OPLL size before surgery and OPLL progress rate after surgery was analyzed.Results A total of 21 patients were included in this study, with an average age of 61.48±4.29 years-old. The mean follow-up time was 3.36±1.92 years. The JOA score of cervi-cal spine was 11.81±1.75 before operationand 14.43±1.69 at the last follow-up time (t=3.8, P<0.01). The progression rate of OPLL length, width and thickness was 3.54± 2.89 mm/year, 0.49± 0.52 mm/year and 0.34± 0.21 mm/year, respectively. Compared with the width and thickness, the average progress speed of the length was statistically significant (t=3.6, P=0.003;t= 3.8, P=0.002). The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1, P=0.559). Linear regression showed that OPLL length progression speed (mm)=0.05×preoperative length+1.23, R2=0.26 and P=0.02. Theprogres-sion rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness. The progression rates of local, segmental, continuous, and mixed OPLL were 3.02±0.26 mm, 2.97±0.65 mm, 3.65±1.14 mm, and 3.82±1.27 mm per year.Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved dur-ing a short-term follow up. CT imaging follow-up showed there was progression of OPLL in length, width and thickness, and the progression rate of length was faster than width and thickness. However, there was no significant difference between the progres-sion of rostral and caudal of OPLL. In addition, short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of seg-mental and limited OPLL.
作者
徐广宇
邹飞
姜建元
马晓生
夏新雷
吕飞舟
Xu Guangyu;Zou Fei;Jiang Jianyuan;Ma Xiaosheng;Xia Xinlei;Lyu Feizhou(Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China;Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第24期1530-1536,共7页
Chinese Journal of Orthopaedics
关键词
颈椎
后纵韧带骨化
体层摄影术
螺旋计算机
随访研究
Cervical vertebrae
Ossification of posterior longitudinal ligament
Tomography, spiral computed
Follow-up studies
