胸椎黃韌帶骨化癥合并硬脊膜粘連的影像學分析_《中國修復重建外科雜志》

作者：

神興勤 ^1,2 , 孫天威 ² , 方釗 ² , 孟德福 ¹ , 胡煒 ^1,2 , 張學利 ²

1 天津醫科大學研究生院（天津，300070）;;
2 天津市人民醫院暨南開大學人民醫院脊柱外科;

關鍵詞：

黃韌帶骨化癥硬脊膜粘連車軌征鋸齒狀線征影像學分析

DOI：

10.7507/1002-1892.20130091

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目的通過對胸椎黃韌帶骨化癥（ossification of the ligamentum flavum，OLF）合并硬脊膜粘連患者的影像學表現進行回顧性分析，總結OLF合并硬脊膜粘連的特征性影像學表現。方法回顧分析2010年1月－2012年9月行OLF手術的85例患者臨床資料。按照患者術前MRI和CT檢查結果是否同時存在“車軌征”及“鋸齒狀線征”將其分為研究組和對照組。研究組患者同時具有兩種影像學表現，共34例；對照組不同時或不具有兩種影像學表現，共51例。以術中剝離黃韌帶時所見硬脊膜與黃韌帶粘連作為診斷硬脊膜粘連的“金標準”。將術前影像學檢查結果與“金標準”進行比較，并分別計算研究組和對照組術前影像學檢查的敏感性、特異性和陽性似然比（陽性似然比 gt; 5表示具有參考價值， gt; 10表示具有診斷價值），判斷術前影像學檢查有無參考或診斷價值。結果研究組患者中26例術中可見硬脊膜粘連，男10例，女16例；8例術中未見硬脊膜粘連，男6例，女2例。對照組中2例術中可見硬脊膜粘連，均為存在“鋸齒狀線征”女性患者；49例術中未見硬脊膜粘連，男14例，女35例。“車軌征”+“鋸齒狀線征”的敏感性為92.9%，特異性為86.0%，陽性似然比為6.6；單純“車軌征”的敏感性為92.9%，特異性為64.9%，陽性似然比為2.6；單純“鋸齒狀線征”的敏感性為100%，特異性為77.2%，陽性似然比為4.4。結論胸椎OLF患者術前CT和MRI檢查提示為“車軌征” +“鋸齒狀線征”對術前OLF合并硬脊膜粘連的診斷具有參考價值。

引用本文： 神興勤,孫天威,方釗,孟德福,胡煒,張學利. 胸椎黃韌帶骨化癥合并硬脊膜粘連的影像學分析. 中國修復重建外科雜志, 2013, 27(4): 414-417. doi: 10.7507/1002-1892.20130091 復制

1.	Fong SY, Wong HK. Thoracic myelopathy secondary to ligamentum flavum ossification. Ann Acad Med Singapore, 2004, 33(3): 340-346.
2.	Sun XZ, Chen ZQ, Qi Q, et al. Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification: clinical article. J Neurosurg Spine, 2011, 15(4): 386-392.
3.	Kang KC, Lee CS, Shin SK, et al. Ossification of the ligamentum flavum of the thoracic spine in the Korean population. J Neurosurg Spine, 2011, 14(4): 513-519.
4.	Sanghvi AV, Chhabra HS, Mascarenhas AA, et al. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors afecting preoperative neurological status. Eur Spine J, 2011, 20(2): 205-215.
5.	Lang N, Yuan HS, Wang HL, et al. Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases. Eur Spine J, 2012. [Epub ahead of print].
6.	Young WF, Baron E. Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis. J Clin Neurosci, 2001, 8(2): 129-132.
7.	景成偉, 王佩, 倪東道, 等. 胸腰段椎管狹窄癥的臨床特點和治療. 中國矯形外科雜志, 2012, 20(3): 193-195.
8.	蘇峰, 張春林, 陰彥林, 等. 胸椎管狹窄患者硬膜外粘連的處理對策. 中國脊柱脊髓雜志, 2009, 19(4): 255-257.
9.	Li M, Meng H, Du J, et al. Management of thoracic myelopathy caused by ossification of the posterior longitudinal ligament combined with ossification of the ligamentum flavum—a retrospective study. Spine J, 2012, 12(12): 1093-1102.
10.	Galhardo AP, da Costa Leite C, Gebrim EM, et al. The correlation of research diagnostic criteria for temporomandibular disorders and magnetic resonance imaging: a study of diagnostic accuracy. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 115(2): 277-284.
11.	楊克虎. 循證醫學. 北京: 人民衛生出版社, 2007: 150-165.
12.	Guo JJ, Luk KD, Karppinen J, et al. Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976), 2009, 35(1): 51-56.
13.	孫垂國, 陳仲強, 劉忠軍, 等. 胸椎黃韌帶骨化癥術后遠期療效分析. 中華外科雜志, 2012, 50(5): 426-429.
14.	Miyakoshi N, Shimada Y, Suzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of thethoracic spine. J Neurosurg, 2003, 99(3 Suppl): 251-256.
15.	Hur H, Lee JK, Lee JH, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum. J Korean Neurosurg Soc, 2009, 46(3): 189-194.
16.	楊勇, 王建華, 霍洪軍, 等. 多椎板整塊切除治療胸椎管狹窄癥. 中華骨科雜志, 2007, 27(11): 814-819.
17.	楊忠, 雪原, 張超, 等. 胸椎黃韌帶骨化合并硬脊膜骨化的手術策略. 中國修復重建外科雜志, 2012, 26(4): 401-405.

1. Fong SY, Wong HK. Thoracic myelopathy secondary to ligamentum flavum ossification. Ann Acad Med Singapore, 2004, 33(3): 340-346.
2. Sun XZ, Chen ZQ, Qi Q, et al. Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification: clinical article. J Neurosurg Spine, 2011, 15(4): 386-392.
3. Kang KC, Lee CS, Shin SK, et al. Ossification of the ligamentum flavum of the thoracic spine in the Korean population. J Neurosurg Spine, 2011, 14(4): 513-519.
4. Sanghvi AV, Chhabra HS, Mascarenhas AA, et al. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors afecting preoperative neurological status. Eur Spine J, 2011, 20(2): 205-215.
5. Lang N, Yuan HS, Wang HL, et al. Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases. Eur Spine J, 2012. [Epub ahead of print].
6. Young WF, Baron E. Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis. J Clin Neurosci, 2001, 8(2): 129-132.
7. 景成偉, 王佩, 倪東道, 等. 胸腰段椎管狹窄癥的臨床特點和治療. 中國矯形外科雜志, 2012, 20(3): 193-195.
8. 蘇峰, 張春林, 陰彥林, 等. 胸椎管狹窄患者硬膜外粘連的處理對策. 中國脊柱脊髓雜志, 2009, 19(4): 255-257.
9. Li M, Meng H, Du J, et al. Management of thoracic myelopathy caused by ossification of the posterior longitudinal ligament combined with ossification of the ligamentum flavum—a retrospective study. Spine J, 2012, 12(12): 1093-1102.
10. Galhardo AP, da Costa Leite C, Gebrim EM, et al. The correlation of research diagnostic criteria for temporomandibular disorders and magnetic resonance imaging: a study of diagnostic accuracy. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 115(2): 277-284.
11. 楊克虎. 循證醫學. 北京: 人民衛生出版社, 2007: 150-165.
12. Guo JJ, Luk KD, Karppinen J, et al. Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976), 2009, 35(1): 51-56.
13. 孫垂國, 陳仲強, 劉忠軍, 等. 胸椎黃韌帶骨化癥術后遠期療效分析. 中華外科雜志, 2012, 50(5): 426-429.
14. Miyakoshi N, Shimada Y, Suzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of thethoracic spine. J Neurosurg, 2003, 99(3 Suppl): 251-256.
15. Hur H, Lee JK, Lee JH, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum. J Korean Neurosurg Soc, 2009, 46(3): 189-194.
16. 楊勇, 王建華, 霍洪軍, 等. 多椎板整塊切除治療胸椎管狹窄癥. 中華骨科雜志, 2007, 27(11): 814-819.
17. 楊忠, 雪原, 張超, 等. 胸椎黃韌帶骨化合并硬脊膜骨化的手術策略. 中國修復重建外科雜志, 2012, 26(4): 401-405.

《中國修復重建外科雜志》

胸椎黃韌帶骨化癥合并硬脊膜粘連的影像學分析

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《中國修復重建外科雜志》

胸椎黃韌帶骨化癥合并硬脊膜粘連的影像學分析

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