脊髓型颈椎病颈前路手术对术后颈椎矢状位平衡参数的影响  

A study of cervical sagittal parameters change after two modus of anterior cervicalsurgery in cervical myelopathy

作　　者：余文超 袁文 陈华江 曹鹏 徐辰 杨晨 Yu Wenchao, Yuan Wen, Chen Huajiang, Cao Peng, Xu Chen, Yang Chen(The Spine Surgery, Changzheng Hospital of the Navy Military Medical University, Shanghai 200003, China)

机构地区：[1]海军医科大学附属上海长征医院脊柱科,上海200003

出　　处：《中华骨科杂志》2018年第21期1285-1292,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈椎椎间盘切除植骨融合术（anterior cervical discectomy fusion，ACDF）及颈椎椎体次全切除植骨融合术（anterior cervical corpectomy fusion，ACCF）治疗脊髓型颈椎病术后对颈椎矢状位平衡参数的影响。方法回顾性分析2013年3月至2014年10月接受颈前路手术且均获得随访的脊髓型颈椎病患者80例。其中ACDF手术组44例，男24例，女20例；年龄（59．5±4．26）岁。ACCF手术组36例，男20例，女16例；年龄（62．5±3．85）岁。分别于术前、术后6个月及末次随访时对所有患者行颈椎正、侧位x线片、颈椎CT三维重建及颈椎MR检查，并分别进行神经功能性评价及颈椎矢状位参数测量，其中神经功能评价包括日本骨科学会（Japanese Orthopaedic Association，JOA）评分、疼痛视觉模拟评分（visu．alanaloguescale，VAS）、颈椎功能障碍指数neck disability index，NDI）。颈椎矢状位平衡参数，包括C2-7 Cobb角、C2-7矢状面轴向距离（sagittal verticalaxis，C2-7SVA）和T1倾斜角。结果80例患者随访时间18-26个月，平均22个月。JOA评分、VAS评分、NDI：ACDF组分别由术前的（8．1±1．4）分、（5．8±1．2）分、（22．2±5．9）分改善至末次随访时（13．2±1．8）分、（1．5±1．4）分、（10．5±4．8）分；ACCF组分别由术前（7．3±1．6）分、（4．9±1．5）分、（24．2±4．3）分改善至末次随访时（13．9±1．1）分、（1．7±1．2）分、（11．3±4．2）分；两组患者JOA评分、VAS评分及NDI评分比较差异均无统计学意义（t=1．544、0．887、1．666，P=0．134、0．382、0．107）。矢状位平衡参数C2-7 Cobb角、C2-7，SVA、T1倾斜角：ACDF组分别由术前的17．5°±4．7°、（20．3±9．3）mm、35．2°±8．6°改善至末次随访时29．50±5．2°、（11．2±8．6）mm、28．7°±8．2°；ACCF组分别由术前的16．8°±5．1°、（19．5±8．6）mm、34．6°±9．1°改善至末次�Objective To analyze cervical sagittal parameters change after anterior cervical discectomy fusion （ACDF） and anterior cervical corpectomy fusion （ACCF） in cervical myelopathy. Methods 80 patients with cervical myelopathy who underwent anterior cervical surgery between March 2013 and October 2014 were analyzed in this study. 44 patients （24 males, 20 females） were operated by ACDF, with an average age of 59.5±4.26 years old and 36 patients （20 males, 16 females） were operated by ACCF, with an average age of 62.5 ± 3.85 years old. Japanese Orthopaedic Association （JOA） scores, visual analogue scale （VAS） and neck disability index （NDI） were obtained in all patients preoperatively, 6 months after surgery and at the latest follow- up. Standing radiographs of cervical spine, CT （3D） and MR were obtained preoperatively, 6 months after surgery and at the latest follow-up. Cervical sagittal parameters were assessed with the following 3 parameters： C2-7 Cobb angle, C2-7 sagittal vertical axis （C2-7 SVA） and T±-Slope. Results All the patients were followed up from 18 to 26 months, with the average time of 22 months. The group of ACDF： JOA scores, VAS scores and NDI scores changed from 8.1±1.4, 5.8±1.2, 22.2±5.9 to 13.2±1.8, 1.5±1.4, 10.5± 4.8. The group of ACCF： JOA scores, VAS scores and NDI scores changed from 7.3＋1.6, 4.9±1.5, 24.2±4.3 to 13.9±1.1, 1.7±1,2, 11.3±4.2. There was no significant difference of JOA scores, VAS scores and NDI scoresbetween two group （t=1.544, 0.887, 1.666;P=0.134, 0.382, 0.107）. The group of ACDF： C2-7 Cobb angle, C2-7 SVA and T1-Slope angle changed from 17.5°±4.7°、（20.3±9.3）mm、35.2°±8.6°to 29.50±5.2°、（11.2±8.6）mm、28.7°±8.2°. The group of ACCF： C2-7 Cobb angle, C2-7 SVA and Ti-Slope angle changed from 16.8°±5.1°、（19.5±8.6）mm、34.6°±9.1° to 25.3°±4.2°、（15.7±9.2）mm、30.3°±7.9°, with significant difference between the two group （t=2.75, 2.45, 2.34; P=0.039, 0.045, 0.043）

关 键 词：颈椎病 颈椎 外科手术 

分 类 号：R687.3[医药卫生—骨科学]