摘要
目的比较颈前入路两种手术方式的颈椎矢状面参数及治疗脊髓型颈椎病的疗效,并对颈椎矢状面参数及疗效的相关性进行分析。方法将68例脊髓型颈椎病患者按照手术方式不同分为A组[采用颈椎椎体次全切除融合术(ACCF)治疗,34例]和B组[采用颈前路椎间盘切除融合术(ACDF)治疗,34例]。比较两组颈椎矢状面参数[C_(2~7) Cobb角、T_(1)倾斜角(T_(1)S)、C_(2~7)颈椎矢状面轴向距离(C_(2~7) SVA)、胸廓入口角(TIA)]及临床疗效,并对颈椎矢状面参数及疗效相关性进行分析。结果患者均获得12个月随访。①颈椎矢状面参数:各项颈椎矢状面参数两组术后各时间点与术前比较大体有统计学意义(P<0.05);C_(2~7) Cobb角、C_(2~7) SVA两组术后各时间点比较大体有统计学意义(P<0.05)。②JOA评分、疼痛VAS评分、NDI指数:术后3个月两组比较差异均有统计学意义(P<0.05)。末次随访时JOA评分改善率两组比较差异无统计学意义(P>0.05)。③相关性分析:术前,JOA评分与C_(2~7) Cobb角、T_(1)S呈正相关,JOA评分与疼痛VAS评分呈负相关;术后12个月,JOA评分与C_(2~7) Cobb角呈正相关、与C_(2~7) SVA呈负相关,T_(1)S与C_(2~7) Cobb角呈正相关。结论ACDF和ACCF均可有效改善脊髓型颈椎病脊髓压迫症状,且短期内ACDF较ACCF在患者主观感受方面更具优势。颈椎矢状面参数与临床疗效相关,故采用颈前入路手术治疗颈椎退变性疾病时,要尽可能将颈椎矢状面参数恢复至正常范围。
Objective To compare the cervical sagittal plane parameters and the curative effect of cervical spondylotic myelopathy treated by two kinds of surgical methods via anterior cervical approach,and to analyze the correlation between the cervical sagittal plane parameters and the curative effect.Methods The 68 patients with cervical spondylotic myelopathy were divided into two groups according to different surgical methods:group A[treated by anterior cervical corpectomy and fusion(ACCF),34 cases]and group B[treated with anterior cervical discectomy and fusion(ACDF),34 cases].The following data were compared between two groups,including the cervical sagittal plane parameters[C_(2~7) Cobb angle,T_(1) slope angle(T_(1)S),C_(2~7) sagittal vertical axis(C_(2~7) SVA),thoracic inlet angle(TIA)]and clinical efficacy,and the correlation between the cervical sagittal plane parameters and efficacy was analyzed.Results All patients were followed up for 12 months.①At the postoperative each time-point,the various cervical sagittal plane parameters of the two groups had statistical difference,compared with those of the two groups before operation(P<0.05);the C_(2~7) Cobb angle and C_(2~7) SVA showed statistical significance,compared with the preoperative data(P<0.05).②JOA score,pain VAS,and NDI index:there were statistical differences between the two groups at 3 months after surgery(P<0.05).At the last follow-up,there was no statistical difference in the improvement rate of JOA score between the two groups(P>0.05).③Correlation analysis:at the preoperation,JOA score was positively correlated with C_(2~7) Cobb angle and T_(1)S,while JOA score was negatively correlated with pain VAS;at 12 months after surgery,the JOA score was positively correlated with C_(2~7) Cobb angle,negatively correlated with C_(2~7) SVA;and T_(1)S was positively correlated with C_(2~7) Cobb angle.Conclusions Both ACDF and ACCF can effectively improve the symptoms of spinal cord compression in cervical spondylosis patients,and in the short term,ACDF has an advantage over ACCF in subjective perception of patients.The cervical sagittal plane parameters are related to the clinical efficacy,so when using anterior cervical approach surgery to treat cervical degenerative diseases,the cervical sagittal plane parameters should be restored to the normal range as far as possible.
作者
王春增
赵猛
张建伟
胡孟子
拾坤
张兆川
刘光旺
马超
WANG Chun-zeng;ZHAO Meng;ZHANG Jian-wei;HU Meng-zi;SHI Kun;ZHANG Zhao-chuan;LIU Guang-wang;MA Chao(Dept of Orthopaedics,the Central Hospital of Xuzhou City,Xuzhou,Jiangsu 221000,China)
出处
《临床骨科杂志》
2023年第5期639-644,共6页
Journal of Clinical Orthopaedics
基金
江苏省徐州市卫健委引进临床医学专家团队项目(编号:2019TD002)。
关键词
颈椎病
颈椎前路
矢状面参数
疼痛
cervical spondylosis
anterior approach
cervical sagittal parameter
pain
