脊髓型颈椎病手术治疗后的近中期JOA评分变化规律  

Early and medium-term profile of modified JOA score for cervical spondylotic myelopathy after surgery

作　　者：张一龙[1] 周非非[1] 孙宇[1] 刘忠军[1] 党耕町[1] 

机构地区：[1]北京大学第三医院骨科 北京市海淀区花园北路49号,100191

出　　处：《中国脊柱脊髓杂志》2015年第1期13-17,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：在回顾性队列研究中探讨脊髓型颈椎病患者手术治疗后的近中期JOA评分变化规律。方法 ：收集北京大学第三医院骨科于2008年2月～2011年11月收治并有完整随访资料的113例诊断为脊髓型颈椎病并接受手术治疗的患者资料。术前使用改良JOA评分（mJOA）评价患者的神经功能障碍程度,术后3个月、术后1年和末次随访时再次对患者进行mJOA评价。分析患者术后mJOA评分的变化规律,统计每例患者mJOA评分达到最大值的时间,应用Logistic回归分析不同随访时间点m JOA评分中不同部分的贡献情况。结果：本组患者随访32.7±10.8个月（24～60个月）。mJOA从术前的11.8±2.9分,改善至术后3个月的14.5±2.2分、术后1年的15.1±2.1分和末次随访时的15.2±2.3分,均较术前明显改善（P〈0.01）。mJOA达到最大值的时间为术后16.7±4.1个月（3～36个月）。Logistic回归分析结果显示mJOA评分中各部分对术后总体改善率的贡献不同：术后三次随访时,患者在感觉功能上的恢复均较运动功能和膀胱功能明显。结论：脊髓型颈椎病患者在术后近中期可以取得较好的疗效,其中以感觉功能恢复更为显著,mJOA分数在术后16.7个月达到峰值。Objectives： To investigate the short-term and mid-term profile of modified JOA（modified Japanese Orthopedic Association） score following surgery for cervical spondylotic myelopathy in a cohort study. Methods： The sample comprised 113 patients who underwent surgical treatment for cervical spondylotic myelopathy in our hospital between February 2008 and November 2011. m JOA score which was used to evaluate the neurologic dysfunction was recorded before surgery, 3 months after surgery, 1 year after surgery and at final follow-up. The feature of neurologic dysfunction before surgery and the profile of m JOA after surgery were analyzed. Each patient′s m JOA score peak time and contribution of different time points to the total m JOA score were analyzed by Logistic regression. Results： The follow-up time was 24-60 months（mean 32.7 ±10.8months）. The m JOA score improved from 11.8 ±2.9 before surgery to 14.5 ±2.2 at 3 months after surgery,15.1±2.1 at 1 year after surgery, and 15.2±2.3（P〈0.01） at final follow-up. m JOA reached its maximum at16.7±4.1 months（3-36 months） after surgery. Bivariate logistic regression showed that different part of m JOA contributed variously to the recovery rate of m JOA and motor function improvement contributed more than sensory improvement at three different follow-ups. Conclusions： Patients benefit from surgery, motor function improvement contributes more to m JOA score and m JOA reachs its maximum at 16.7 months after surgery.

关 键 词：脊髓型颈椎病 疗效评价 改良JOA评分 

分 类 号：R681.5[医药卫生—骨科学]