胸椎黄韧带骨化椎管侵占与神经损害的关系  

Correlation between spinal canal encroachment and neurologic deficits in thoracic ossification of ligamentum flavum

作　　者：刘宁[1] 陈仲强[1] 齐强[1] 郭昭庆[1] 

机构地区：[1]北京大学第三医院骨科,100083

出　　处：《中华骨科杂志》2007年第7期481-484,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨胸椎黄韧带骨化椎管侵占引发脊髓损害的临界值,建立脊柱多节段病变中确定责任节段的影像学诊断标准。方法采用病例对照研究,病例组取2002年1月至2007年4月因胸椎黄韧带骨化症行手术治疗者43例;对照组取2006年6月至2007年4月CT检查发现胸椎黄韧带骨化,而就诊前无明确神经损害者22例。在CT片上测量椎管矢状径、椎管发育性矢状径、椎管面积、椎管发育性面积,计算椎管矢状径残余率、椎管面积残余率。病例组患者的神经损害程度用JOA评分确定。结果影像学上椎管面积残余率与JOA评分相关性最大（r=0.449,P=0.003）。椎管面积残余率临界值取80%时诊断总符合率最高,其诊断灵敏度为93.0%,特异度为95.5%。结论（1）胸椎黄韧带骨化椎管侵占程度与神经损害程度相关,椎管面积残余率可以反映神经损害程度。（2）CT椎管面积残余率小于80%可作为胸椎黄韧带骨化引发脊髓损害的影像学标准。Objective To provide critical value of ossification of ligamentum flavum （OLF） induced spinal canal narrowing in development of thoracic myelopathy in thoracic OLF patients, and establish a CT- based diagnostic criterion for discriminating pathogenic segments in situation of muhisegmental spinal cord compression in thoracic OLF. Methods Case-control study was conducted. 43 patients who underwent surgery because of myelopathy caused by thoracic OLF between January 2002 and April 2007 were enrolled as myelopathy group. 22 patients who were identified by CT-scans to have thoracic OLF but without definite neurolagic deficits before the examination were served as controls. CT examinations of the two groups were reviewed. The canal sagittal diameter, canal developmental sagittal diameter, canal cross-sectional area, canal developmental cross-sectional area and the OLF induced residual ratio of both canal sagittal diameter and canal area were measured and calculated. The parameter that had the highest correlation intensity with JOA score was put forward to represent spinal encroachment. Frequency graph was drawn to show the number of myelopathy patients and asymptomatic controls in each interval of the chosen spinal encroachment parameter. Thus the critical value of the parameter differentiating myelopathy group and control group was demonstrated and then tested by ROC curve method. Results Canal area residual ratio has significant correlation with JOA score （r=0.449, P=0.003）. Canal area residual ratio less than 80%, as diagnostic criterion for OLF-induced myelopathy, has the sensitivity of 93.0%, specificity of 95.5%. Conclusion 1） Spinal canal encroachment has correlation with neurologic deficits in patients with thoracic OLF and canal area residual ratio is able to reflect neurologic deficits. 2） CT-based canal area residual ratio less than 80% can serve as critical value for the diagnosis of OLF-induced myelopathy.

关 键 词：胸椎 黄韧带 椎管狭窄 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R686[医药卫生—骨科学]