【关键词】 颈椎;后纵韧带骨化;发病机制
后纵韧带起自第2颈椎,沿诸椎体后面抵于骶管,其分为两层,浅层为一坚强韧带,自颅底垂直下行,在侧方延伸达椎间孔;深层呈齿状,锥体钩椎关节的关节囊一些纤维即始于此层〔1〕。随着年龄增长,在众多因素作用下,后纵韧带组织中新生异位骨结构形成而逐渐发生骨化,导致椎管、椎间孔狭窄,压迫脊髓、神经根,临床上出现脊髓损害症状及神经根刺激症状,即为后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)。OPLL是一种病因尚未明确的病理现象,据统计,脊柱后纵韧带骨化中,70%发生于颈椎,胸椎仅占15%,国内外未发现有发生于腰椎的报道。颈椎OPLL症是脊髓病的主要病因之一〔2〕,其预后差异很大,症状从一直处于无症状的稳定状态到短时间内出现四肢瘫痪〔3〕。颈椎OPLL的发生有系统因素和局部因素,系统因素包括年龄、饮食、糖或钙代谢异常、激素功能障碍和基因等;局部因素包括椎间盘退变、椎体不稳和解剖位置等。国内外 23 Kamiya M,Harada A,Mizuno M,et al.Association between a polymorphism of the transform in growth factor betal gene and genetic susceptibility ossification of the posterior longitudinal ligament in Japanese patient〔J〕.Spine,2001;26:12647.
24 Onari K,Akiyama N,Kondo S,et al.Longterm followup results of anterior inter body fusion applied for cervical myelopathy due to ossification of the posterior longitudinal ligament〔J〕.Spine,2001;26(5):48893.
25 Mercer S,Phty B,Bogda N,et al.The ligaments and annulus fibrosus of human adult cervical intervertebral discs〔J〕.Spine,1999;24(7):61928.
26 Fujimura Y,Nakamura M,Toyama Y.Influence of minor traumaon surgical result in patient with cervical OPLL〔J〕.J Spine Discord,1998;11:1620.
27 Epstein NE.Advanced cervical spondylosis with Ossification into the posterior longitudinal ligament and resultant neurologic sequelae〔J〕. Spinal Disord,1996;9(6):47784. |