K线阳性颈椎后纵韧带骨化症患者后路术后神经功能改善多因素分析  

Multivariate Analysis of Neurological Function Improvement After Posterior Surgery in Patients with K-ray Positive Ossification of the Posterior Longitudinal Ligament

作　　者：谢政 皮国富[1] 孙建广[1] 黄世磊[1] 罗成汉[1] 李峰[1] 许志明 吴钰涵 XIE Zheng;PI Guo-fu;SUN Jian-guang;HUANG Shi-lei;LUO Cheng-han;LI Feng;XU Zhi-ming;WU Yu-han(Department of orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]郑州大学第一附属医院骨科,河南郑州450000 [2]河南科技大学护理学院,河南洛阳471003

出　　处：《河南医学研究》2020年第6期999-1002,共4页Henan Medical Research

摘　　要：目的探讨椎管内骨化灶占率、手术方式及颈椎矢状位参数等因素对K线阳性颈椎后纵韧带骨化症(OPLL)患者术后神经功能恢复的影响。方法回顾性分析行颈椎后路手术治疗的56例K线阳性颈椎后纵韧带骨化症患者的临床资料。通过测量颈椎X线片术前及术后T1倾斜角、C2~C7 Cobb角和C2~C7 SVA值。统计术前及术后随访时四肢肌力变化、JOA评分、VAS评分及NDI指数,应用SPSS 19.0软件分析数据,运用回归模型分析手术方式、T1倾斜角及椎管内骨化灶占率等因素对患者术后神经功能恢复的影响。结果 56例患者术后各项神经功能评分及四肢肌力均改善(均P<0.01),椎管内骨化灶占率对预后JOA改善率及NDI变化的影响差异有统计学意义(均P<0.05)。当骨化灶椎管占率>46%时,术后神经功能改善较差。当术前SVA在正常范围内且>19.21 mm时,术后可获得较好JOA改善及上肢肌力恢复。结论 K线阳性OPLL患者,术前椎管内骨化灶占率是影响患者预后的重要因素,当骨化灶占率>46%时,术后神经功能改善较差。Objective To explore the influence of factors such as the percentage of ossification focus in spinal canal, the mode of operation and the parameters of sagittal position of cervical vertebra on the prognosis of patients with K-line positive cervical vertebra ossification of the posterior longitudinal ligament(OPLL).Methods The clinical data of 56 patients with K-line positive OPLL after posterior cervical surgery were retrospectively analyzed. T1 tilt angle, C2-C7 Cobb angle and C2-C7 SVA value were measured by cervical X-ray before and after operation. The changes of limb myodynamia, JOA score, VAS score and NDI index during preoperative and postoperative follow-up were counted. The data were analyzed by SPSS 19.0 software, and the regression model was used to analyze the effects of operation mode, T1 inclination angle and the rate of intraspinal ossification on the recovery of postoperative neurological function.Results All neurological functions and limb muscle strength were significantly improved in 56 patients after operation(all P<0.01). The rate of intraspinal ossification had a significant effect on the improvement rate of JOA and the changes of NDI(all P<0.05). When the proportion of ossified spinal canal was more than 46%, the improvement of neurological function was poor after operation. When the preoperative SVA was in the normal range and larger than 19.21 mm, the improvement of JOA and the recovery of upper limb muscle strength could be obtained after operation.Conclusion In patients with K-ray positive OPLL, the intra-spinal canal rate of ossification before operation was an important factor affecting the prognosis of operation. When the rate was more than 46%, the improvement of neurological function was poor after operation.

关 键 词：后纵韧带骨化症 颈椎 K线 神经功能 矢状位参数 

分 类 号：R686.5[医药卫生—骨科学]