揭盖法治疗胸椎黄韧带骨化症的预后分析  

Prognosis Factors of the Thoracic Ossification of Ligament flavum by the Decompression of Vertebral Canal

作　　者：苑乾 魏运栋 王少锋 彭祥平 郝占元 Yuan Qian;Wei Yundong;Wang Shaofeng(Spinal Surgery,Jizhong Energy Xingtai Mining Group General Hospital,Hebei 054000,China)

机构地区：[1]冀中能源邢台矿业集团总医院脊柱骨科,054000

出　　处：《医学研究杂志》2018年第11期126-131,共6页Journal of Medical Research

基　　金：河北省邢台市科技计划项目(2017ZC048)

摘　　要：目的探索揭盖法治疗胸椎黄韧带骨化症预后的影响因素分析。方法选取诊断为单节段胸椎黄韧带骨化症于笔者医院手术治疗的患者共71例,记录其病程、血压、血脂、丙氨酸氨基转移酶、血肌酐,年龄、性别、体重指数、术前JOA评分、手术节段、椎管面积残余率、T_2WI髓内高信号、脊髓受压分度、CT矢状位椎管前后径残余率、CT横断面椎管前后径残余率(中央)、CT横断面椎管前后径残余率(侧界)、CT横断面椎管前后径残余率(旁正中)。同时对患者进行随访,在随访期间发生不良预后的患者定义为不良预后组,病情无恶化者定义为预后良好组,分析影响患者预后的因素;运用ROC曲线分析较大危险因素对预测患者预后风险的敏感度和特异性。结果 71例患者中,失访6例,预后良好为52例; 13例发生终点事件,此为预后不良组。多因素COX回归结果显示CT横断面椎管前后径残余率(旁正中)以及椎管面积残余率对患者预后有显著影响;两者比较,前者较椎管面积残余率的影响程度高(RR=3. 547、2. 324); ROC曲线下CT横断面椎管前后径残余率(旁正中)的AUC为0. 810(95%CI:0. 699～0. 922),其敏感度和特异性分别为63. 5%、83. 3%。结论揭盖法治疗胸椎黄韧带骨化患者的效果较好,CT横断面椎管前后径残余率(旁正中)对胸椎黄韧带骨化患者预后风险率的大小有较好的预测能力,有望作为相应患者的常规评估指标广泛应用于临床。Objective To investigate the prognosis factors of the thoracic ossification of Ligament Flavum by decompression of vertebral canal.Methods A total of 71 patients were diagnosed as thoracic ossification of ligament flavum in our hospital,and their course of disease,blood pressure,blood lipid,glutamic pyruvic transaminase,serum ereatinine,age,sex,body mass index,JOA score,image type,operative segment,spinal canal area residual rate,T2WI intramedullary high signal,spinal compression grading,canal diameter occupying ratio on sagittal CT,Canal diameter occupying ratio on axial CT (midline),canal diameter occupying ratio on axial CT (boundary),canal diameter occupying ratio on axial CT (paramedian)were recorded.All patients with adverse outcomes were defined as the poor prognosis group during the follow -up period.The patients with positive outcomes were defined as the good prognosis group.We analyzed the faetors that affect the prognosis of patients and the sensitivity and specificity in the larger risk factors of patients according to the receiver operating characteristic curve.Results Among the 71 patients,6 patients were lost to follow -up.The number of good prognosis was 52 and the number of good prognosis was 13.COX's proportional harzard model showed that patients with canal diameter occupying ratio on axial CT (paramedian)and spinal canal area residual rate had significant influence on the prognosis of the patients.The Canal diameter occupying ratio on axial CT (paramedian)and spinal canal area residual rate had the highest influence (RR =3.547,2.324).The area curves of JOA score was 0.810,(95%CI:0.699-0.922),and their sensitivity and specificity were 63.5%,83.3%.Conclusion The treatment of decompression of vertebral canal on the thoracic ossification of ligament flavum is better and canal diameter occupying ratio on axial CT (paramedian)has good predictive ability for the prognosis which is expected to be one of the routine indexes for patients and wide speard.

关 键 词：揭盖法 胸椎黄韧带骨化 预后 

分 类 号：R681.5[医药卫生—骨科学]