前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响  

Effect of anterior cervical spine surgery on cervical sagittal parameters in patients with cervical disc herniation

作　　者：刘蔚[1] 唐鹏宇 罗勇骏 周快 凡进[1] 周炜[1] 殷国勇[1] 张宁[1] 蔡卫华[1] 

机构地区：[1]南京医科大学第一附属医院骨科,江苏210029

出　　处：《脊柱外科杂志》2017年第3期167-170,共4页Journal of Spinal Surgery

基　　金：国家自然科学基金(81371967);江苏省"六大人才高峰"C类资助项目(2014-WSN-012)

摘　　要：目的探讨前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响。方法 2011年1月—2016年9月在本院行前路颈椎椎间盘切除融合术(ACDF)及前路颈椎椎体次全切除融合术(ACCF)治疗的颈椎椎间盘突出症患者159例,男79例,女80例;年龄(51.85±9.60)岁。在MRI上测量颈椎矢状位参数,包括C_(2~7) Cobb角、T_1倾斜角(T_1SA)、颈倾角(NTA)和胸廓入口角(TIA),采用配对t检验比较手术前后各参数的差异。根据T_1SA大小分为低T_1SA组(T_1SA≤20°,53例)、中T_1SA组(20°<T_1SA≤30°,81例)和高T_1SA组(T_1SA>30°,25例),采用χ~2检验比较不同T_1SA组间各个节段退变率的差异。结果术后C_(2~7) Cobb角、T_1SA和NTA的测量结果与术前相比,差异有统计学意义(P<0.05),TIA与术前相比,差异无统计学意义。159例病例中病变共累及311个节段,其中C_5/C_6最多,为102个;C_4/C_5次之,为91个。C_3/C_4、C_4/C_5、C_5/C_6和C_6/C_7退变率在不同T_1SA组之间差异有统计学意义(P<0.05),随着T_1SA增加,C_3/C_4和C_4/C_5退变率逐渐增加,C_5/C_6和C_6/C_7退变率逐渐降低。结论前路手术可能通过增加颈椎椎间盘突出症患者C_(2~7) Cobb角进而增加T_1SA,从而更有力地维持颈椎生理曲度;随着T_1SA的增加,退变节段有由下往上发展的趋势。Objective To analyze the influence of anterior cervical spine surgery on cervical sagittal parameters in patients with cervical disc herniation. Methods From January 2011 and September 2016,159 patients with cervical disc herniation who underwent anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) were retrospectively studied. The study included 79 males and 80 females,whose age was(51.85±9.60) years old. The cervical sagittal parameters were measured on MRI,including C_(2-7) Cobb's angle,T1 slope angle(T_1SA),neck tilting angle(NTA) and thoracic inlet angle(TIA),and the data were analyzed by paired samples t test between pre-and post-operation. According to preoperative T_1SA,the patients were divided into low T_1SA group(T_1SA ≤ 20°,53 cases),normal T_1SA group(20°< T_1SA ≤ 30°,81 cases) and high T_1SA group(T_1SA > 30°,25 cases),and the degeneration rates were analyzed by chi-square test between different T_1SA groups. Results Postoperative C_(2-7) Cobb's angle,T_1SA and NTA showed statistically significant difference(P <0.05) compared with the preoperative data,but TIA showed no significant difference(P > 0.05). Of the 159 patients,a total of 311 segments were identified as degeneration,with C_5/_C_6 being 102,which was the most maximum and C4/C5 being 91,taking the second place. The differences in degeneration rates of C_3/C_4,C_4/C_5,C_5/C_6 and C_6/C_7 were statistically significant between the different T_1SA groups(P < 0.05). With the increase of T_1SA,the degeneration rate of C_3/C_4 and C_4/C_5 increased and that of C_5/C_6 and C_6/C_7 decreased gradually. Conclusion Anterior cervical spine surgery may increase the C_(2-7) Cobb's angle and then increase the T_1SA in patients with cervical disc herniation,thereby more effectively maintaining the lordosis of the cervical spine;with the increase of T_1SA,the degenerated segment has a tendency to develop from lower level to higher level.

关 键 词：颈椎 椎间盘移位 椎间盘切除术 脊柱融合术 内固定器 图像解释 计算机辅助 

分 类 号：R681.53[医药卫生—骨科学]