腰背部轻微外伤对胸椎黄韧带骨化症患者手术效果的影响  

Influence of minor back trauma on surgical outcomes in patients with thoracic ossification of ligamentum flavum

作　　者：吴东进[1] 蒋振松[2] 孙建民[2] 王修文[1] 张程[1] 谯勇[1] 王大川[2] 马胜忠[1] 宋杨[1] 高春正[1] 

机构地区：[1]山东大学第二医院脊柱外科,济南250033 [2]山东省立医院脊柱外科

出　　处：《中华医学杂志》2011年第26期1830-1833,共4页National Medical Journal of China

摘　　要：目的探讨腰背部轻微外伤对胸椎黄韧带骨化症（TOLF）患者手术效果的影响。方法回顾性研究山东大学第二医院1997年6月至2009年8月和山东省立医院1996年5月至2009年8月连续收治的有完整随访资料TOLF患者94例。根据有无腰背部轻微外伤史分为轻微外伤组16例和无外伤组78例。比较两组在性别、年龄、病程长短、病变累及部位和节段数、MRI上髓内异常信号（IMSC）出现率、术前及终末随访日本骨科协会（JOA）评分和恢复率等的差异，分析与终末随访JOA评分及恢复率相关的因素；并探讨手术时机对疗效的影响。结果终末随访时轻微外伤组和无外伤组患者JOA评分分别为4．0±1．4和8．4±1．7，均高于术前的3．2±1．4和5．4±1．1（P=0．009和P=0．000）。轻微外伤组的发病年龄（50±11岁）小于无外伤组（58±8岁）（P=0．046），IMSC出现率（75．0％）高于无外伤组（25．6％）（P=0．000），术前术后JOA评分均低于无外伤组（均P=0．000）。多元线性回归分析示终末随访JOA评分与患者轻微外伤和IMSC呈负相关（r=-1．82和r=-1．87，均P=0．000），与术前JOA评分呈正相关（r=0．60，P=0．000），而术后恢复率与患者轻微外伤和IMSC呈负相关（r=-26．26和r=-33．70，均P=0．000）。未发现手术时机对手术效果有明显影响（P=0．147）。结论有腰背部轻微外伤史的TOLF患者术后恢复差，外伤是其恢复不良的高危因素。Objective To retrospectively explore the influences of minor back trauma on surgical outcomes in patients with thoracic ossification of ligamentum flavum （TOLF） and preliminarily detect its possible causes. Methods A total of 94 TOLF patients were divided into two groups according to the absence or presence of minor back trauma： MT （minor trauma, n = 16） and NT （no trauma, n = 78 ）. They were compared in terms of gender, age, duration of symptoms, levels of involvement, numbers of involved segments, ratio of intramedullary signal changes （IMSC） , pre- ＆ post-operative JOA （Japanese Orthopedic Association） score, recovery rate （RR） at the final follow-up. Multiple regression analysis was employed to elucidate the causes related with the surgical outcomes. The MT group was further divided into two subgroups according to the intervals between trauma and surgery to clarify the influences of surgical timing on the efficacies. Results The JOA scores were 4. 0 ±1.4 and 8.4 ±1.7 respectively in MT and NT groups at the final follow-up. The neurological status of patients improved in both groups （ MT： P = 0. 009, NT： P = 0. 000）. The patients were younger in MT groups（50 ±11 years） than those in NT groups（58 ± 8 years） （P =0. 046）. The ratio of IMSC was higher in MT groups（75.0% ） than that in NT groups（25.6% ） （P = 0. 000）. The pre- ＆ post-operative JOA scores were lower in MT groups than those in NT groups（both P = 0. 000）. Multiple regression analysis revealed that the postoperative JOA score at the final follow-up was positively related with the preoperative JOA score （ r = 0. 60, P = 0. 000 ） and negatively with trauma and IMSC （ r = - 1.82 and r = - 1.87, P = 0. 000） while the final postoperative RR were negatively related with trauma and IMSC （r = - 26. 26 and r = - 33.70, P = 0. 000）. The surgical timing after trauma did not influence the efficacies （P = 0. 147）. Conclusion The TOLF patients with minor back trauma have a worse pos

关 键 词：骨化 黄韧带 胸椎 创伤和损伤 外科手术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]