胸椎黄韧带骨化症合并硬脊膜粘连的影像学分析_《中国修复重建外科杂志》

作者：

神兴勤 ^1,2 , 孙天威 ² , 方钊 ² , 孟德福 ¹ , 胡炜 ^1,2 , 张学利 ²

1 天津医科大学研究生院（天津，300070）;;
2 天津市人民医院暨南开大学人民医院脊柱外科;

关键词：

黄韧带骨化症硬脊膜粘连车轨征锯齿状线征影像学分析

DOI：

10.7507/1002-1892.20130091

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的通过对胸椎黄韧带骨化症（ossification of the ligamentum flavum，OLF）合并硬脊膜粘连患者的影像学表现进行回顾性分析，总结OLF合并硬脊膜粘连的特征性影像学表现。方法回顾分析2010年1月－2012年9月行OLF手术的85例患者临床资料。按照患者术前MRI和CT检查结果是否同时存在“车轨征”及“锯齿状线征”将其分为研究组和对照组。研究组患者同时具有两种影像学表现，共34例；对照组不同时或不具有两种影像学表现，共51例。以术中剥离黄韧带时所见硬脊膜与黄韧带粘连作为诊断硬脊膜粘连的“金标准”。将术前影像学检查结果与“金标准”进行比较，并分别计算研究组和对照组术前影像学检查的敏感性、特异性和阳性似然比（阳性似然比 gt; 5表示具有参考价值， gt; 10表示具有诊断价值），判断术前影像学检查有无参考或诊断价值。结果研究组患者中26例术中可见硬脊膜粘连，男10例，女16例；8例术中未见硬脊膜粘连，男6例，女2例。对照组中2例术中可见硬脊膜粘连，均为存在“锯齿状线征”女性患者；49例术中未见硬脊膜粘连，男14例，女35例。“车轨征”+“锯齿状线征”的敏感性为92.9%，特异性为86.0%，阳性似然比为6.6；单纯“车轨征”的敏感性为92.9%，特异性为64.9%，阳性似然比为2.6；单纯“锯齿状线征”的敏感性为100%，特异性为77.2%，阳性似然比为4.4。结论胸椎OLF患者术前CT和MRI检查提示为“车轨征” +“锯齿状线征”对术前OLF合并硬脊膜粘连的诊断具有参考价值。

引用本文： 神兴勤,孙天威,方钊,孟德福,胡炜,张学利. 胸椎黄韧带骨化症合并硬脊膜粘连的影像学分析. 中国修复重建外科杂志, 2013, 27(4): 414-417. doi: 10.7507/1002-1892.20130091 复制

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.	景成伟, 王佩, 倪东道, 等. 胸腰段椎管狭窄症的临床特点和治疗. 中国矫形外科杂志, 2012, 20(3): 193-195.
8.	苏峰, 张春林, 阴彦林, 等. 胸椎管狭窄患者硬膜外粘连的处理对策. 中国脊柱脊髓杂志, 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.	杨克虎. 循证医学. 北京: 人民卫生出版社, 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.	孙垂国, 陈仲强, 刘忠军, 等. 胸椎黄韧带骨化症术后远期疗效分析. 中华外科杂志, 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.	杨勇, 王建华, 霍洪军, 等. 多椎板整块切除治疗胸椎管狭窄症. 中华骨科杂志, 2007, 27(11): 814-819.
17.	杨忠, 雪原, 张超, 等. 胸椎黄韧带骨化合并硬脊膜骨化的手术策略. 中国修复重建外科杂志, 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. 景成伟, 王佩, 倪东道, 等. 胸腰段椎管狭窄症的临床特点和治疗. 中国矫形外科杂志, 2012, 20(3): 193-195.
8. 苏峰, 张春林, 阴彦林, 等. 胸椎管狭窄患者硬膜外粘连的处理对策. 中国脊柱脊髓杂志, 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. 杨克虎. 循证医学. 北京: 人民卫生出版社, 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. 孙垂国, 陈仲强, 刘忠军, 等. 胸椎黄韧带骨化症术后远期疗效分析. 中华外科杂志, 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. 杨勇, 王建华, 霍洪军, 等. 多椎板整块切除治疗胸椎管狭窄症. 中华骨科杂志, 2007, 27(11): 814-819.
17. 杨忠, 雪原, 张超, 等. 胸椎黄韧带骨化合并硬脊膜骨化的手术策略. 中国修复重建外科杂志, 2012, 26(4): 401-405.

《中国修复重建外科杂志》

胸椎黄韧带骨化症合并硬脊膜粘连的影像学分析

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《中国修复重建外科杂志》

胸椎黄韧带骨化症合并硬脊膜粘连的影像学分析

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