摘要
目的通过对颈椎人工间盘置换术(ACDR)术后患者的长期随访,回顾性探讨术前因素对ACDR术后长期随访手术节段活动度影响,进一步完善ACDR术手术适应证的选择。方法回顾性分析北京积水潭医院脊柱外科2003年12月至2008年12月71例行单节段Bryan ACDR的颈椎退行性疾病症患者的临床资料,所有患者均行10年临床随访。其中男44例,女27例;术后随访时间(129±14)个月;手术时年龄(45±8)岁。术前及随访影像学评估包括通过颈椎动力位X光片测量颈椎置换节段屈伸活动度,通过颈椎侧位中立位X光片测量术前椎间隙高度,通过CT及影像学重建评价椎旁骨化(PO)等级,临床症状评估包括日本骨科协会评分(JOA)、颈椎功能障碍指数量表(NDI)。采用二元logistic回归分析进行随访时手术节段活动度影响因素的多因素分析,采用受试者工作特征(ROC)曲线对差异有统计学意义的指标计算其最佳截断值。结果患者术前和末次随访时手术节段活动度分别为9.7°±4.5°和8.7°±5.4°,前后比较差异无统计学意义(P>0.05)。单因素分析发现ACDR术后患者长期随访手术节段活动度与性别、年龄、手术节段、术前症状学诊断、术前手术节段活动度、术前JOA及NDI评分无相关性(均P>0.05),与患者影像学诊断(1:颈椎间盘突出症;2:退行性颈椎管狭窄症)和术前PO评级存在相关性(均P<0.05)。多因素分析发现术前手术节段活动度(OR=1.228,95%CI:1.012~1.489,P<0.05)与PO分级在总体检验中有统计学意义(OR=0.190,95%CI:0.085~0.424,P<0.05),影像学诊断差异无统计学意义(P>0.05)。ROC曲线计算术前手术节段活动度与PO分级最佳截断值分别为9.185°和2.5级,其曲线下面积分别为0.86和0.72。结论ACDR术对于颈椎退行性疾病可取得满意的长期疗效,有效保留了颈椎整体活动度及置换节段活动度。术前节段活动度好、椎旁骨化等级较低的患者术后远期获得良好的节段活动度的机会较大。
Objective To investigate the influence of the preoperative factors on the segmental range of motion(ROM)during long-term follow-up after artificial cervical disc replacement(ACDR),so as to further improve the selection of surgical indications for ACDR.Methods Retrospective analysis was performed on 71 patients with cervical degenerative diseases who underwent single-segment Bryan ACDR in Beijing Jishuitan Hosptial from December 2003 to December 2008,and a 10-year clinical follow-up was conducted.Among the patients,44 were males and 27 were females,with a mean age of(45±8)years at operation.The mean follow-up time was(129±14)months.Preoperative and follow-up imaging evaluation including measurement of the segmental range of motion(ROM)by cervical X-ray,and preoperative height of intervertebral space was measured by cervical lateral X-ray.According to CT and coronal reconstruction,the grade of paravertebral ossification(PO)was assessed.Clinical symptoms assessment including the Japanese Orthopaedic Association scoring(JOA),the Neck Disability Index(NDI)evaluation was performed preoperatively.Multivariate logistic regression analysis was used to analyze the influencing factors of the range of motion of the surgical segment during follow-up.The best cut-off value was calculated by receiver operating characteristic(ROC)curve.Results The preoperative and follow-up ROM at the operated segment was 9.7°±4.5°and 8.7°±5.4°,respectively(P>0.05).Univariate analysis revealed that the postoperative segmental ROM was not significantly correlated with the factors including the surgical level,gender,age,and preoperative clinical diagnosis(1:Radiculopathy;2:Myelopathy;3:Mixed type),preoperative segmental ROM,preoperative JOA score and preoperative NDI score(all P>0.05),and was significantly correlated with imaging diagnosis(1:cervical disc herniation;2:degenerative cervical stenosis),preoperative PO grade(both P<0.05).The multi-factor analysis showed that preoperative segmental ROM(OR=1.228,95%CI:1.012-1.489,P<0.05)and PO grade(OR=0.190,95%CI:0.085-0.424,P<0.05)had significance in the overall test,but imaging diagnosis had no significance in the overall test(P>0.05).The optimal cutoff value of preoperative segmental ROM and PO grade was 9.185°and grade 2.5 assessed by ROC curve,and the area under the ROC curve was 0.86 and 0.72,respectively.Conclusions ACDR surgery can achieve satisfactory long-term effects for patients with nerve root type,spinal cord type and mixed type cervical degenerative diseases,and effectively retain the overall ROM of the cervical spine and the ROM of replacement segments.Patients with good preoperative segmental ROM and lower PO levels have a greater chance of obtaining good segmental ROM in the long-term postoperatively.
作者
韩骁
王祺龙
段芳芳
刘波
何达
田伟
Han Xiao;Wang Qilong;Duan Fangfang;Liu Bo;He Da;Tian Wei(Department of Spine Surgery,Beijing Jishuitan Hosptial,Beijing Research Institute of Traumatology and Orthopedics,Beijing 100035,China;Beijing Research Institute of Traumatology and Orthopedics,Beijing 100035,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第23期1816-1821,共6页
National Medical Journal of China
基金
首都卫生发展科研专项基金(CFH2020-2-1121)
北京积水潭医院自然基金培育计划(ZR-201912)
北京积水潭医院“学科骨干”计划专项(XKGG202103)。
关键词
颈椎
颈椎退行性疾病
人工间盘置换术
适应证
节段活动
Cervical vertebrae
Cervical degenerative diseases
Artificial cervical disc replacement
Indications
Segmental range of motion
