胸椎黄韧带骨化患者弥漫性特发性骨肥厚症患病率及其分布特征分析  

Prevalence and distribution of diffuse idiopathic skeletal hyperostosis in patients with thoracic ossification of the ligamentum flavum

作　　者：张保良 孙垂国[1] 陈广辉 陈希 杨晓曦 范天奇 陈仲强[1] Zhang Baoliang;Sun Chuiguo;Chen Guanghui;Chen Xi;Yang Xiaoxi;Fan Tianqi;Chen Zhongqiang(Department of Orthopaedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学工程研究中心,脊柱疾病研究北京市重点实验室,100191

出　　处：《中华骨科杂志》2021年第13期872-880,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072479,81772381)。

摘　　要：目的探讨胸椎黄韧带骨化(thoracic ossification of the ligamentum flavum,TOLF)住院患者弥漫性特发性骨肥厚症(diffuse idiopathic skeletal hyperostosis,DISH)的患病率及其分布特征。方法回顾性分析2018年1月至2019年6月连续收治的132例TOLF患者的病历资料,男80例,女52例;年龄25~75岁。根据患者术前X线片及CT影像,确定DISH的患病率,并比较不同性别、不同年龄组及不同骨化类型TOLF患者间的DISH患病率;观察DISH的节段分布特征,比较上胸椎(T1~T4)、中胸椎(T5~T8)和下胸椎(T9~T12)骨化区域的分布差异;根据Meta分级系统分析DISH的骨化程度。将TOLF患者分为DISH组和非DISH组,比较两组患者的人口学特征(年龄、性别、体质指数等)。结果132例TOLF患者中49例合并DISH,DISH患病率为37.1%,男性患病率(46.3%)约为女性(23.1%)的2倍(χ2=8.806,P=0.003)。<40岁组、40~49岁组、50~59岁组、60~69岁组和≥70岁组患者DISH患病率分别为20.0%、28.0%、34.4%、44.0%、66.7%,且随年龄增长而增加。长节段型TOLF患者DISH患病率为45.1%,明显高于短节段型TOLF的24.0%(χ2=5.937,P=0.015)。DISH最常累及T8,9水平(91.8%)。49例DISH患者共365个骨化节段,骨化节段数平均为7.4个,且随年龄增长而增加;分布于上、中和下胸椎的骨化节段分别占26.03%、40.54%和33.15%;Ⅰ级骨化78个(21.4%),Ⅱ级骨化104个(28.5%),Ⅲ级骨化183个(50.1%)。DISH组患者年龄平均为57.96岁,大于非DISH组的53.87岁(t=2.024,P=0.045);DISH组男性占73.47%,明显高于非DISH组的46.99%(χ2=8.806,P=0.003);DISH组患者平均身高(t=2.564,P=0.012)和体重(t=2.191,P=0.030)明显高于非DISH组,而体质指数及合并基础疾病构成(糖尿病、高血压等)的差异均无统计学意义。结论TOLF患者DISH的患病率为37.1%,男性、高龄及长节段型TOLF患者DISH患病率更高;DISH韧带骨化常发生于中、下胸椎,T8,9为最常累及的节段;骨化物长度可能随年龄增长而增加;TOLF患者中DISH组与Objective To analyze the prevalence and distribution characteristics of diffuse idiopathic skeletal hyperostosis(DISH)in hospitalized patients with thoracic ossification of the ligamentum flavum(TOLF).Methods The clinical records of 132 consecutive TOLF patients from January 2018 to June 2019 were retrospectively studied.DISH was identified by the preoperative X-ray and CT and its prevalence was calculated.The prevalence of patients with different genders,different age groups and different ossification types was compared.The segmental distribution of DISH and the distribution in the upper(T1-T4),middle(T5-T8),and lower thoracic spine(T9-T12)were analyzed.Ossification degree of DISH was evaluated based on the Meta scoring system.The demographic characteristics(age,gender,BMI,etc.)were compared between DISH and non-DISH group.Results Forty-nine patients was diagnosed as DISH with the prevalence of 37.1%in all included cases.The prevalence was about twice as high in male(46.3%)than in female(23.1%)(χ2=8.806,P=0.003).The prevalence in the age groups of<40,40-49,50-59,60-69 and≥70 years was 20.0%,28.0%,34.4%,44.0%,and 66.7%,respectively.The prevalence in long-segment TOLF patients(45.1%)was significantly higher than that in short-segment TOLF patients(24.0%)(χ2=5.937,P=0.015).DISH most frequently affected T8,9 levels(91.8%).The total number and mean number of ossified segments were 365 and 7.4,respectively.Ossification lesions in the upper,middle,lower thoracic spine accounted for 26.03%,40.54%,and 33.15%,respectively.Grade I,grade II,and grade III ossification accounted for 21.4%,28.5%and 50.1%,respectively.The mean age of the DISH group was older than the non-DISH group(t=2.024,P=0.045).The proportion of male patients in the DISH group was significantly higher than that in the non-DISH group(χ2=8.806,P=0.003).The average height and weight in the DISH group were significantly greater than those in the non-DISH group(t=2.564,P=0.012;t=2.191,P=0.030),whereas no significant differences in BMI and constituent ratio

关 键 词：胸椎 黄韧带 骨化 异位性 骨肥厚 弥漫性特发性骨骼 患病率 流行病学研究 

分 类 号：R687.3[医药卫生—骨科学]