慢性压迫性颈脊髓病患者行C3-C7单开门椎板成形术后发生轴性症状影响因素分析  

Influencing factors of axial symptoms in patients with chronic compressive cervical myelopathy after C3-C7 single-door laminoplasty: a Logisitic analysis

作　　者：刘春 亢志强 杨辉 冯皓宇 Liu Chun;Kang Zhiqiang;Yang Hui;Feng Haoyu(Department of Orthopedics,Shanxi Second Provincial People′s Hospital,Taiyuan 030012,China)

机构地区：[1]山西省第二人民医院骨科,太原030012 [2]山西白求恩医院山西医学科学院骨科

出　　处：《中国药物与临床》2020年第15期2509-2513,共5页Chinese Remedies & Clinics

摘　　要：目的探讨C3-C7单开门椎板成形术治疗慢性压迫性颈脊髓病术后出现轴性症状(AS)的影响因素。方法选取2017年6月至2018年10月我院收治的因慢性压迫性颈脊髓病行颈椎后路C3-C7单开门椎板成形术的患者128例,根据术后轴性症状的发生情况,将患者分为AS组和非AS组。记录并比较2组患者的性别、年龄、病程、术前日本骨科协会(JOA)脊髓功能评分、JOA改善率、术前颈痛情况、术后早期功能锻炼情况等一般资料,手术时间、术中出血量、佩戴颈托时间等手术情况,以及颈椎生理曲度、术前脊髓受压率、开门角度、术后脊髓漂移程度和颈椎总活动度等影像学参数。采用单因素和多因素Logistic回归分析,分析AS发生的影响因素,采用R3.3.2和软件包RMS将筛选出的独立危险因素构建列线图预测模型,计算C-index指数并用于评价模型的区分度,内部验证和外部验证测试其符合度。结果随访至术后12个月,128例患者中61例发生AS(AS组),67例未发生AS(非AS组)。单因素分析结果显示,2组患者的年龄、术前脊髓受压率、术前颈椎总活动度、颈椎曲度丢失度以及术后早期功能锻炼差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄增加、颈椎曲度丢失度大及术前脊髓受压率高是AS发生的独立危险因素;术前颈椎总活动度大和术后早期功能锻炼是AS发生的保护因素。由列线图预测模型可知,年龄>55岁为22.5分,术前脊髓受压率>28.35%为52.5分,术前颈椎总活动度≤29.57°为33分,颈椎曲度丢失度>9.5°为31分,未接受术后早期功能锻炼为37.5分,以上积分相加所得总分(176.5分)对应的值即为模型预测的AS发生率(78.3%)。本模型一致性指数(C-in-dex)为0.871,内部验证C-index指数为0.865,下降0.006;外部验证C-index指数为0.852。结论年龄增加、颈椎曲度丢失度大及术前脊髓受压率高是AS发生的独立危险因素;术前颈椎Objective To investigate the influence factors of axial symptoms(AS)after C3-C7 single-door laminoplasty in the treatment of chronic compressive cervical myelopathy.Methods A total of 128 patients with chronic compressive cervical myelopathy admitted to our hospital between June 2017 and October 2018,who underwent C3-C7 single-door laminoplasty at posterior cervical spine,were included in the study.According to the occurrence of postoperative axial symptoms,the patients were divided into AS group and non-AS group.The general data such as gender,age,course of disease,the Japanese Orthopaedic Association(JOA)spinal cord function score,JOA improvement rate,preoperative cervical pain,and early postoperative functional exercise,and surgical conditions such as operation time,intraoperative blood loss,duration of wearing a cervical collar,as well as imaging parameters such as physiological curvature of cervical spine,preoperative spinal cord compression rate,opening angle,postoperative spinal cord drift degree and total cervical range of motion were recorded and compared between the two groups.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of AS.R software(R3.3.2)and software package RMS were used to construct the nomogram prediction model of the screened independent risk factors.The C-index was calculated to evaluate the differentiation of the model,and the conformity was tested by internal verification and external verification.Results During 12 months of follow-up after the operation.Sixty-one of 128 patients developed AS(AS group),67 patients did not develop AS(non-AS group),and the incidence rate was 47.7%.Univariate analysis showed that there were statistically significant differences between the two groups in age,preoperative spinal cord compression rate,preoperative total cervical range of motion,preoperative cervical curva-ture loss,and early postoperative functional exercise(P<0.05).Multivariate Logistic regression analysis showed that in-creasing age,larg

关 键 词：脊髓压迫症 单开门椎板成形术 轴性症状 

分 类 号：R687.3[医药卫生—骨科学]