摘要
[目的]探讨颈椎前路单椎体次全切减压植骨融合术后矢状位参数变化与临床疗效的相关性。[方法]回顾分析2014年1月～2017年6月接受颈椎前路单椎体次全切减压植骨融合术(ACCF)手术且随访资料完整的51例脊髓型颈椎病患者的资料,其中女24例,男27例,年龄40～74岁,平均(53.88±8.68)岁;C_4椎体次全切17例(33.33%),C_5椎体次全切25例(49.02%),C6椎体次全切9例(17.65%)。记录日本骨科协会评估治疗分数(JOA)及脊髓神经功能改善率、疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI),并测量C_(2～7)Cobb角、C_(2～7)矢状位轴向距离(C_(2～7)SVA)、T1倾斜角(T1S),分析颈椎矢状位参数改变与临床效果的相关性。[结果]随访时间12～28个月,平均(17.18±4.73)个月。颈椎JOA评分由术前的(7.78±1.21)分增加至术后12个月的(12.75±1.35)分,VAS评分由(3.08±1.11)分减少至(1.16±0.70)分,颈椎NDI指数由(46.22±3.47)分减少至(24.53±5.85)分,差异均具有统计学意义(P<0.05)。影像测量方面:C_(2～7)Cobb角由术前的(11.75±7.49)°增加至术后12个月的(16.27±8.41)°,C_(2～7)SVA由(19.29±8.11) mm增加至(23.55±9.36) mm,T1S由(23.98±5.94)°增加至(26.20±6.34)°,差异均具有统计学意义(P<0.05)。无论是术前或术后1年,还是手术前后的差值T1S均与C_(2～7)Cobb角、C_(2～7)SVA呈正相关(P<0.05),C_(2～7)Cobb角与C_(2～7)SVA呈负相关(P<0.05)。而C_(2～7)Cobb角差值与VAS评分差值、NDI指数差值呈负相关(P<0.05),与JOA评分差值呈正相关(P<0.05);C_(2～7)SVA差值与JOA评分差值、JOA改善率存在负相关(P<0.05)。手术前后C_(2～7)Cobb角与VAS评分均存在负相关(P<0.05),C_(2～7)SVA与JOA评分均存在负相关(P<0.05)。[结论]颈椎前路单椎体次全切减压植骨融合术治疗脊髓型颈椎病具有确切疗效,颈椎矢状位参数的改变与临床疗效有一定的相关性。
[Objective] To explore the correlation among radiographic parameters in sagittal plane and clinical scores in anterior cervical corpectomy and fusion(ACCF) for cervical spondylotic myelopathy.[Methods] A retrospective study was conducted on 51 patients who underwent ACCF for cervical spondylotic myelopathy from January 2014 to June 2017 in our hospital.The patients,including 27 males and 24 females aged 40~74 years with an average of(53.88±8.68) years,had ACCF performed involving C4 in 17 cases((33.33%),C5 in 25 cases(49.02%) and C6 in 9 cases(17.65%).The Japanese Orthopaedic Association(JOA) scores and its function improvement rate,visual analogue scale(VAS) for pain as well as neck disability index(NDI) were marked for clinical evaluation,whereas radiographic measurements on sagittal plane,such as C2~7 Cobb angle,C2~7 sagittal vertical axis and thoracic 1 slope(T1 S),were conducted.The correlation among these parameters was analyzed.[Re-sults] The follow-up period lasted for 12~28 months with an average of(17.18±4.73) months.The JOA score significantly increased from(7.78 ± 1.21) preoperatively to(12.75 ± 1.35)at 12 months postoperatively,while the VAS score significantly decreased from(3.08±1.11) to(1.16±0.70),and the NDI significantly decreased from(46.22 ± 3.47) to(24.53 ±5.85),with statistically significant differences between two time points(P<0.05).In term of radiographic assessment,the C2~7 Cobb angle significantly increased from(11.75±7.49)° before surgery to(16.27±8.41)° at 12 months postoperatively,in addition,the C2~7 SVA increased from(19.29±8.11) to(23.55±9.36),and the T1 S significantly increased from(23.98±5.94)° to(26.20±6.34)°,there were statistically significant differences between the two time points in aforesaid parameter(P<0.05).The T1 S preoperatively,at 12 months postoperatively and in difference between the two time points was positively correlated with C2~7 Cobb angle and C2~7 SVA(P<0.05),while the C2~7 Cobb angle was negatively correlated with C2~7 SVA(P<0.05).In addition,the C2~7 Cobb angle difference was negatively correlated with the VAS difference and NDI difference(P<0.05),whereas positively correlated with the JOA score difference(P<0.05).The C2~7 SVA difference was negatively correlated with JOA score difference and JOA improvement rate(P<0.05).There was a negative correlation between C2~7 Cobb angle and VAS score before and after surgery,whereas a negative correlation between C2~7 SVA and JOA score.[Conclusions] Anterior cervical corpectomy and fusion does have definitive efficacy for single-segment cervical spondylotic myelopathy,while the variations of cervical sagittal parameters has a certain correlation with the clinical efficacy.
作者
钟远鸣
廖俊城
李嘉琅
赵犀
霍杰钊
邓文仕
刘萌
ZHONG Yuan-ming;LIAO Jun-cheng;LI Jia-lang;ZHAO Xi;HUO Jie-zhao;DENG Wen-shi;LIU Meng(The First Affiliated Hospital,Guangxi University of Chinese Medicine,Nanning 530001,China;Guangxi University of Chinese Medicine,Nanning 530023,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第3期193-198,共6页
Orthopedic Journal of China
基金
国家自然科学基金资助项目(编号:81760874)
