T_1倾斜角对颈椎后纵韧带骨化患者后路单开门椎板成形术后颈椎曲度的影响  

Impact of T_1-slope on cervical curvature change after posterior single door laminoplasty for treatment of cervical ossifi cation of posterior longitudinal ligament

作　　者：臧法智 陈华江[1] 王建喜[1] 施靓宇 

机构地区：[1]第二军医大学附属长征医院脊柱外科,上海200003

出　　处：《脊柱外科杂志》2016年第1期26-29,共4页Journal of Spinal Surgery

摘　　要：目的评价T_1倾斜角对颈椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）患者颈椎后路单开门椎板成形术后颈椎曲度的影响。方法选取2014年1月—10月,因颈椎OPLL接受颈椎后路单开门椎板成形术病例38例,男20例,女18例;年龄44~75岁,平均53.3岁,随访5.1~6.6个月,平均6.0个月;手术节段C3~6 18例,C3~7 12例,C4~7 8例。记录术前和随访时疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科学会（Japanese Orthopaedic Association,JOA）评分,计算VAS、JOA评分改善率。通过X线片测量术前T_1倾斜角、术前和随访时C2~7 Cobb角及颈椎活动度（range of motion,ROM）,计算C2~7 Cobb角改变值,即颈椎曲度改变值。运用SPSS 18.0软件分析数据,以明确T_1倾斜角与颈椎曲度改变之间的相关性。结果根据T_1倾斜角中位数将病例分为2组,2组病例之间性别、年龄、手术节段、随访时间、术前和随访时颈椎ROM、随访时Cobb角、VAS评分改善率及JOA评分改善率差异均无统计学意义（P〉0.05）。T_1倾斜角与随访时颈椎曲度改变明显相关,较大T_1倾斜角组（T_1倾斜角≥26.9°,n=19）病例在随访时的颈椎曲度改变明显高于较小T_1倾斜角组（T_1倾斜角〈26.9°,n=19）,差异具有统计学意义（P〈0.05）。结论对于具有较大T_1倾斜角的OPLL病例,颈椎后路单开门椎板成形术后颈椎曲度丢失的风险有可能增加,提示在拟行颈椎后路单开门手术或其他颈椎后路术式之前,在考虑患者颈椎Cobb角等评估因素的同时,也应将T_1倾斜角作为一项重要考虑因素。Objective To evaluate the relationship between T_1-slope and the cervical curvature change after cervical posterior single door laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament（OPLL）. Methods From January 2014 to October 2014,38 patients of OPLL treated by cervical posterior single door laminoplasty were selected. Of all 38 cases,20 males and 18 females at the age of 44-75,mean 53.3,were followed-up for 5.1-6.6 months,mean 6.0 months. Operation segment ：18 cases in C3-6,12 cases in C3-7,8 cases in C4-7. The preoperative and postoperative visual analogue scale（VAS） and Japanese Orthopaedic Association（JOA） scores were recorded to calculate the improvement rate. The preoperative T_1-slope angle,preoperative and postoperative range of motion（ROM） and Cobb＇s angle on roentgenographs were measured. The change value of cervical curvature（Cobb＇s angle） was calculated. Results The patients were divided into 2 groups according to the median of T_1-slope angle. The differences were not statistically significant in gender,age,operation segment,cervical ROM at preoperation and follow-up,Cobb＇s angle at follow-up,improvement rate of VAS and JOA scores between the 2 groups（P 0.05）. In the high T_1-slope angle group（T_1-slope ≥ 26.9°,n=19）,change of cervical curvature was obviously higher than that of the low T_1-slope angle group（T_1-slope 26.9°,n=19）;the difference was statistically significant（P 0.05）. Conclusion In cases of high T_1-slope angle,posterior single door laminoplasty may increase the risk of postoperative cervical curvature loss. Before cervical posterior single door laminoplasty surgery,the T_1-slope angle should be taken into consideration,besides the evaluation index such as cervical Cobb＇s angle.

关 键 词：颈椎 骨化 后纵韧带 椎板成形术 脊柱弯曲 

分 类 号：R681.531[医药卫生—骨科学]