颈前路椎间融合术后矢状位参数变化与临床疗效的相关性研究  

Relationship between alterations of cervical sagittal parameters and clinical outcomes after cervical anterior discectomy and fusion

作　　者：刘涛 邱水强[1] 黄宇峰[2] 王善金[2] 罗振东[1] 吴德升[2] 

机构地区：[1]上海市江湾医院骨科,200434 [2]同济大学附属东方医院脊柱外科,上海200120

出　　处：《中华骨科杂志》2018年第2期79-85,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈前路椎间融合术后颈椎矢状位参数变化与临床疗效的相关性。方法回顾性分析2010年1月至2015年12月接受颈前路椎间融合术227例颈椎病患者的病例资料，男109例，女118例；年龄34～78岁，平均（52．2±10．7）岁。随访时间12-60个月，平均（21．1±9．0）个月。比较术前及术后1年颈椎日本骨科协会（Japanese Orthopaedic Association，JOA）评分及其改善率、颈肩臂疼痛视觉模拟（visual analogue scale，VAS）评分及颈椎功能指数（neck disability index，NDI）。测量术前及术后1年颈椎矢状位参数，包括T1倾斜角（T1 slope，T1S）、颈椎前凸角、矢状面平衡（sagittal vertical axis，SVA），比较矢状位参数变化与临床疗效的相关性。结果术后1年T1S由术前25．4°±8．5°增加至27．9°±8．2°，前凸角由12．7°±8．5°增加至15．3°±9．5°，SVA由（21．0±12．3）mm增加至（24．3±11．4）mm，差异均有统计学意义（P〈0．001）。术后1年JOA评分由术前（8．5±4．0）分提高至（13．0±2．4）分；VAS评分由（2．7±1．8）分降低至（0．2±0．4）分；NDI指数由48．2％±8．2％降低至27．1％±11．1％，差异均有统计学意义（P〈0．001）。术前T1S与前凸角及SVA呈正相关性（r=0.311，0．213；P=0．000，0．001），而前凸角与SVA呈负相关性（r=-0．246，P=O．000）。术后1年T1S与前凸角及SVA呈正相关性（r=0．390，0．392；P=0．000，0．000），而前凸角与SVA呈负相关性（r=-0．131，P=0．048）。术后1年前凸角改变值与JOA改变值呈正相关性（r=0．294，P=0．000），与NDI改变值呈负相关性（r=0．141，P=0．034）。结论颈前路椎间融合术治疗颈椎病具有显著临床疗效，且颈椎局部矢状位序列保持相对稳定，手术前后颈椎矢状位参数变化与临床疗效具有一定相关性。Objective To explore the relationships between the alterations of cervical sagittal parameters and clinical outcomes after anterior cervical discectomy and fusion （ACDF）. Methods From January 2010 to December 2015, a total of 227 patients with cervical spondylosis who undelwent ACDF in Dongfang Hospital affiliated Tongji University were analyzed in this study. There were 109 male and 118 female, with an average age of 52.2± 10.7 years （ranged from 34 to 78 years）. The average duration of follow-up after revision surgery was （21.1±9.0） months （12-60 months）. Comparing with Japanese Orthopaedic Association （JOA） score and its improvement rate （IR）, visual analogue scale （VAS） scores and neck disability index （NDI） between preoperation and 1 year follow-up. Cervical alignment was assessed with the following 3 parameters： T1 slope （TIS）, Cobb＇s angle of C2 to C7 and C2-7 sagittal vertical axis （SVA）. And compared the changes of sagittal parameters and clinical efficacy. Results At 1 year follow-up, T1S was increased from 25.40±8.5° to 27.90±8.2°, Cobb＇s angle was increased from 12.7°±8.5° to 15.3°±9.5°, SVA was increased from （21.0± 12.3） mm to （24.30± 11.4） mm, and the differences were statistical significant （P〈 0.001）. JOA score was increased from （8.5±4.0） points to （13.0＋2.4） points at 1 year follow- up, however, VAS score was decreased from 2.7±1.8 points to 0.2±0.4 points, and NDI was decreased from 48.2%＋8.2% to 27.1%± 11.1%, and the differences were statistical significant （P 〈 0.001）. Preoperatively, T,S had positive correlations with both Cobb＇s angle and SVA before operation （r=0.311, 0.213; P=0.000, 0.001）, but Cobb＇s angle had negative correlation with SVA （r=-0.246, P=0.000）. At 1 year follow-up, T1S had positive correlations with Cobb＇s angle and SVA （r=0.390, 0.392; P=0.000, 0.000）, and Cobb＇s angle had negative correlation with SVA （r=-0.131, P=0.048）. At 1 year after operation, th

关 键 词：颈椎病 脊柱融合术 X线 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]