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1、OPLL经典综述讲读王雪鹏杭州市骨科研究所杭州市第一人民医院骨科Ossificationoftheposteriorlongitudinalligament(OPLL)resultsfrompathologicreplacementofthePLLwithlamellarbone,potentiallycausingspinalcordcompressionandneurologicdeteriorationOPLLwasfirstdescribedinJapanesepatientsandhasclassicallyb
2、eenconsideredacauseofmyelopathyinpatientsofEastAsianoriginspondylosismyelopathyradiculopathystenosisdischerniationAmongpatientsinJapanwithcervicalspinedisorders,theincidencehasbeenestimatedat1.9%to4.3%and,inotherAsiancountries,upto3.0%OPLLhasbeenrecognizedasaneti
3、ologyofmyelopathyregardlessofethnicity,withanestimatedincidencerateof0.1%to1.7%amongNorthAmericansandEuropeansPathoanatomyThePLLrunsalongthedorsalsurfaceoftheC1anteriorarchandcervicalvertebralbodiesandconsistsoflongitudinalfibersconfluentwiththetectorialmembranec
4、raniallyandendingatthesacrumcaudallyfunctionally,thePLLresistsspinehyperflexionPathophysiologyThepathologicprocessleadingtoOPLLbeginswithchondroblast-andfibroblast-likespindlecellproliferation,alongwithvascularinfiltrationleadingtoPLLdegenerationandhypertrophy.En
5、dochondralossificationfollows,resultinginitsreplacementwithmaturelamellarboneGenetics,localtissuecharacteristics,andassociatedmedicalcomorbiditieshaveallbeenimplicatedinthisfinalcommonpathwayMedicalcomorbiditiesarealsoassociatedwiththedevelopmentofOPLLUpto50%ofCa
6、ucasianpatientswithOPLLalsohavediffuseidiopathicskeletalhyperostosisHypoparathyroidism,hypophosphatemicrickets,hyperinsulinemia,andobesityhavebeenidentifiedasriskfactorsNaturalHistoryPatientswithOPLLcommonlypresentintheirfifthandsixthdecades,withmenaffectedtwicea
7、softenaswomen.Mostpatientshavesomeneurologicsymptomsatdiagnosis,with28%to39%fulfillingdiagnosticcriteriaformyelopathyInpatientswithmyelopathy,64%haddeteriorated,however,and89%ofpatientswithNurickgrade3or4myelopathywhorefusedsurgeryhadprogressedtoawheelchair-orbed
8、-boundstateRiskfactorsforthedevelopmentofmyelopathyinclude＞60%spinalcanalstenosis,＜6mmofspaceavailableforthecord,increasedcervicalrangeofmotion,andOPLLthatisla
