颈椎后路椎管扩大成形置入微型钛板:矢状面参数变化与修复效果的关系  

Posterior cervical open-door expansive laminoplasty with mini-titanium plate: correlation between cervical sagittal alignment and repair effect

作　　者：顾勇[1] 王强[1] 辛天闻 杨惠林[1] 陈亮[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2016年第44期6570-6576,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81371930);江苏省社会发展-重点专病规范化诊疗项目(BE2015641);江苏省高校自然科学基金面上项目(15KJB320012)~~

摘　　要：背景:颈椎后路单开门椎管扩大成形术是治疗颈椎疾患的良好术式,具有临床疗效确切,操作相对简单,以及并发症少等优点。然而单开门术后颈椎矢状面失衡,前凸角度丢失或轴性痛等的报道并不少见。目的:探讨颈椎后路单开门椎管扩大成形微型钛板置入的疗效与矢状面参数变化之间的关系。方法:回顾性分析2011年1月至2015年6月采用单开门椎管扩大成形微型钛板置入治疗的122例颈椎疾患病例,利用日本骨科协会(JOA)评分、颈椎功能障碍指数及疼痛目测类比评分评估临床疗效;利用C_(2-7) Cobb角、C_(2-7)矢状面轴向距离及C_7倾斜角评估影像学效果;并探讨临床修复效果与影像学参数变化之间的相关性。结果与结论:(1)所有患者均获得随访,随访时间7-32个月;(2)末次随访时JOA评分、颈椎功能障碍指数及颈部目测类比评分均较术前明显改善(P均<0.001),而上肢目测类比评分无明显变化(P=0.142)。末次随访时C_(2-7)矢状面轴向距离较术前增加(P=0.036);而C_(2-7)前凸角及C_7倾斜角与术前相比无明显变化(P=0.092,P=0.184);(3)C_(2-7) Cobb角、C_(2-7)矢状面轴向距离及C_7倾斜角等颈椎矢状位参数的变化与临床指标JOA评分、颈椎功能障碍指数及目测类比评分的改善并无明显相关性(P均>0.05);(4)结果提示,颈椎后路单开门椎管扩大成形微型钛板置入治疗能显著改善患者的神经功能,然而术后颈椎矢状面参数变化与疗效提高并无明显相关性。BACKGROUND：Posterior cervical open-door expansive laminoplasty is one of the simple and effective methods to treat cervical spinal diseases, has satisfactory results but low complications. However, the imbalance of sagittal plan, loss of lordosis or axial pain is often reported recently. OBJECTVE：To analyze the correlation between cervical sagittal alignment and clinical outcomes after laminoplasty. METHODS：Between January 2011 and June 2015, 122 cases of cervical spinal disease, who were treated with open-door expansive laminoplasty with mini-titanium plate, were retrospectively analyzed. Clinical outcomes were evaluated by Japanese Orthopaedic Association, Neck Disability Index and Visual Analogue Scale. Radiographic results were assessed by C2-7 Cobb angle, C2-7 sagittal vertical axis and C7 slope. The correlation between sagittal alignment and clinical outcomes were analyzed. RESULTS AND CONCLUSION：（1） Al patients were fol owed up for 7-32 months. （2） Japanese Orthopaedic Association, Neck Disability Index and Visual Analogue Scale scores were improved in the final fol ow-up （al P〈0.001）. No significant difference in upper limb Visual Analogue Scale scores was determined （P=0.142）. In the final fol ow-up, C2-7 sagittal vertical axis increased （P=0.036）, but neither the C2-7 Cobb angle nor the C7 slope significantly changed （P=0.092, P=0.184）. （3） There were no correlations between sagittal alignment parameters （C2-7 Cobb angle, C2-7 sagittal vertical axis and C7 slope） and clinical outcomes （Japanese Orthopaedic Association, Neck Disability Index and Visual Analogue Scale） （al P＆gt;0.05）. （4） These findings indicated that posterior cervical open-door expansive laminoplasty with mini-titanium plate can significantly improve the neurological function of patients. However, there is no correlation between cervical sagittal alignment and clinical outcomes.

关 键 词：颈椎 椎体成形术 手术后并发症 组织工程 骨科植入物 脊柱植入物 颈椎后路椎管扩大成形术 微型钛板 脊髓型颈椎病 颈椎后纵韧带骨化症 矢状面平衡 神经功能 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]