双节段颈椎前路减压融合内固定对颈椎矢状面平衡的作用  

Effect of two-level anterior cervical discectomy and fusion on cervical sagittal balance

作　　者：孙柏寒 刘永涛 刘猛 郭开今 黄栋 辛兵 Sun Bai-han;Liu Yong-tao;Liu Meng;Guo Kai-jin;Huang Dong;Xin Bing(School of Graduate,Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Orthopedics,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学研究生院,江苏省徐州市221000 [2]徐州医科大学附属医院骨科,江苏省徐州市221000

出　　处：《中国组织工程研究》2018年第31期4943-4948,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:颈椎后路相关手术可以对颈椎矢状平衡产生明显的影响,而颈椎前路减压融合内固定作为颈椎病治疗的"金标准",有关其对颈椎矢状平衡影响的研究却少有报道。目的:分析颈椎前路减压融合内固定对颈椎矢状平衡的影响,以及比较两种不同前路置入移植物固定治疗后恢复生物学功能的组间差异。方法:回顾性分析2014年12月至2017年3月在徐州医科大学附属医院脊柱外科行相邻两节段前路颈椎间盘切除植骨融合术和前路椎体次全切除植骨融合术患者共45例,其中前路颈椎间盘切除植骨融合组21例,前路椎体次全切除植骨融合组24例。比较术前及末次随访时颈椎X射线片影像学参数的变化,包括C_(2-7) Cobb角、C_(2-7)矢状位轴向距离、T1倾斜角及节段角度。采用日本矫形外科学会评分评价神经功能;目测类比评分评价患者颈部及上肢疼痛程度。采用Pearson相关性分析患者各时间点影像学参数间的相关性。结果与结论:随访时间为(14.21±5.73)个月。在末次随访时两组各影像学参数(除T1倾斜角外)较术前相比差异有显著性意义,两组间同时间点各影像学参数(除T1倾斜角外)相比差异均有显著性意义(P <0.05)。两组在末次随访时日本矫形外科学会评分、目测类比评分均低于术前水平,各时间点较术前相比差异有显著性意义(P <0.05)。两组影像学参数Pearson分析结果示:C_(2-7)矢状位轴向距离与C_(2-7) Cobb角呈负相关(r=-0.55,P <0.05);C_(2-7) Cobb角与节段角度呈正相关(r=0.40,P <0.05)。结果证实,颈椎前路手术对T1倾斜角影响较小,术后颈椎前倾不大,前路术式通过人为的增加颈椎曲度来恢复矢状面平衡。两种颈前路术式均可恢复手术节段角度、颈椎曲度及有效的改善神经功能,但前路颈椎间盘切除植骨融合术较前路椎体次全切除植骨融合术在维持术后手术节段角度及颈椎前凸角度方面更具优BACKGROUND:Cervical posterior surgeries exert obvious effects on the sagittal balance of the cervical spine.But,cervical anterior decompression and internal fixation is the“gold standard”for cervical spondylosis,and its effect on the sagittal balance of the cervical spine is little reported.OBJECTIVE:To analyze the effect of cervical anterior decompression and internal fixation on the sagittal balance of the cervical spine and to compare the differences in biological function after implant fixation through two different anterior approaches.METHODS:Forty-five patients undergoing anterior cervical discectomy and fusion(n=21)and anterior cervical corpectomy and fusion(n=24)at Department of Spine Surgery,the Affiliated Hospital of Xuzhou Medical University from December 2014 to March 2017 were enrolled.The imaging parameters of cervical X-ray films were measured at baseline and last follow-up,including C2-7 Cobb angle,C2-7 sagittal vertical axis,T1 slope angle,and segment angle.The Japanese Orthopaedic Association was used to evaluate the neural function.The Visual Analogue Scale was used to assess the degree of neck and upper limb pain.Pearson correlation was used to analyze the correlation among imaging parameters at each time point.RESULTS AND CONCLUSION:The follow-up time was(14.21±5.73)months.At the last follow-up,there were significant differences in the imaging parameters(except T1-slope)compared with those before operation(P<0.05).There were significant differences in the imaging parameters(except T1-slope)at the same time between two groups at 3 months postoperatively and the last follow-up(P<0.05).The Japanese Orthopaedic Association score and Visual Analogue Scale score of both group were significantly decreased postoperatively(P<0.05).The Pearson analysis showed that negative correlations were presented between C2-7 sagittal vertical axis and C2-7 Cobb(r=-0.55,P<0.05).While C2-7 Cobb angle was positively correlated with segmental angle(r=0.40,P<0.05).In summary,the anterior cervical surgery shows lit

关 键 词：颈椎 脊髓型颈椎病 椎间盘切除减压术 椎体次全切除减压术 矢状面平衡 矢状位参数 比较 内固定器 双节段 颈椎序列 组织工程 组织工程 颈椎 内固定器 

分 类 号：R318[医药卫生—生物医学工程]