钟远鸣;廖俊城;李嘉琅;赵犀;霍杰钊;邓文仕;刘萌;

• 1:广西中医药大学第一附属医院
• 2:广西中医药大学

摘要(Abstract)：

[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。

关键词(KeyWords)： 脊髓型颈椎病;前路单椎体次全切减压植骨融合术(ACCF);影像参数;临床疗效

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(编号:81760874)

作者(Author): 钟远鸣;廖俊城;李嘉琅;赵犀;霍杰钊;邓文仕;刘萌;

Email:

DOI:

参考文献(References)：

• [1]赵定麟,侯铁胜,陈德玉,等.现代脊柱外科学[M].上海:世界图书出版社,2006:436.
• [2]Song KJ,Lee KB,Song JH.Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy:a minimum 5-year follow-up study[J].Eur Spine J,2012,21(8):1551-1557.
• [3]Fehlings MG,Wilson JR,Yoon ST,et al.Symptomatic progression of cervical myelopathy and the role of nonsurgical management:a consensus statement[J].Spine(Phila Pa 1976),2013,38(22Suppl 1):S19-20.
• [4]钟远鸣,莫日养,梁梓扬,等.脊髓型颈椎病的手术治疗研究进展[J].中国全科医学,2018,20(8):998-1002.
• [5]徐政,刘艺.颈前路椎体次全切减压植骨融合术后枕骨-颈椎矢状面形态学研究[J].东南国防医药,2018,20(3):258-262.
• [6]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:1982.
• [7]Furlan JC,Catharine CB.Psychometric analysis and critical appraisal of the original,revised,and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy[J].Neurosurg Focus,2016,40(6):E6.
• [8]Wewers ME,Lowe NK.A critical review of visual analogue scales in the measurement of clinical phenomena[J].Res Nurs Health,1990,13(4):227-236.
• [9]Vernon H.The Neck Disability Index:state-of-the-art,1991-2008[J].J Manipulative Physiol Ther,2008,31(7):491-502.
• [10]Harrison DE,Harrison DD,Cailliet R,et al.Cobb method or Harrison posterior tangent method:which to choose for lateral cervical radiographic analysis[J].Spine(Phila Pa 1976),2000,25(16):2072-2078.
• [11]Lee SH,Kim KT,Seo EM,et al.The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults[J].J Spinal Disord Tech,2012,25(2):E41-47.
• [12]Quinn JC,Kiely PD,Lebl DR,et al.Anterior surgical treatment of cervical spondylotic myelopathy:review article[J].HSS J,2015,11(1):15-25.
• [13]Han YC,Liu ZQ,Wang SJ,et al.Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy?A systemic review and meta-analysis[J].PLoS One,2014,9(1):e87191.
• [14]Li J,Zheng Q,Guo X,et al.Anterior surgical options for the treatment of cervical spondylotic myelopathy in a long-term follow-up study[J].Arch Orthop Trauma Surg,2013,133(6):745-751.
• [15]Knott PT,Mardjetko SM,Techy F.The use of the T1sagittal angle in predicting overall sagittal balance of the spine[J].Spine J,2010,10(11):994-998.
• [16]Smith JS,Lafage V,Ryan DJ,et al.Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume:analysis of 56 preoperative cases from the AO Spine North America Myelopathy Study[J].Spine(Phila Pa 1976),2013,38(22 Suppl 1):S161-170.
• [17]Jun HS,Kim JH,Ahn JH,et al.T1slope and degenerative cervical spondylolisthesis[J].Spine(Phila Pa 1976),2015,40(4):E220-226.
• [18]Lee SH,Son ES,Seo EM,et al.Factors determining cervical spine sagittal balance in asymptomatic adults:correlation with spinopelvic balance and thoracic inlet alignment[J].Spine J,2015,15(4):705-712.
• [19]Tang JA,Scheer JK,Smith JS,et al.The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery[J].Neurosurgery,2015,76(Suppl 1):S14-21.
• [20]Carreon LY,Smith CL,Dimar JR,et al.Correlation of cervical sagittal alignment parameters on full-length spine radiographs compared with dedicated cervical radiographs[J].Scoliosis Spinal Disord,2016,11(1):12.
• [21]Kim TH,Lee SY,Kim YC,et al.T1slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy[J].Spine(Phila Pa 1976),2013,38(16):E992-997.2018-10-11