Bryan颈椎人工间盘置换术术前颈椎退变程度与术后异位骨化相关性的定量分析  

Quantitative analysis of the degeneration of cervical spine and the correlation to the heterotopic ossification after artificial cervical disc replacement

作　　者：周非非[1] 李舒扬 赵衍斌 张凤山[1] 潘胜发[1] 孙宇[1] Zhou Feifei;Li Shuyang;Zhao Yanbin;Zhang Fengshan;Pan Shengfa;Sun Yu(Department of Orthopaedics,Beijing Key Labratory of Spinal Disease Research,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中华医学杂志》2021年第13期945-949,共5页National Medical Journal of China

摘　　要：目的通过10年以上随访资料分析Bryan人工颈椎间盘置换术术前患者适应证选择相关因素及参考值。方法回顾性分析2004年1月至2008年8月北京大学第三医院由同一组医生采用单节段Bryan颈椎人工间盘置换术的44例患者的资料。纳入研究的所有患者均具备10年以上随访。影像学采用McAfee分级对术后异位骨化(HO)形成进行评估;采用“9分法”颈椎退变评分系统,在颈椎X线片上对术前手术节段退变程度进行评估。通过单因素分析和多因素logistic回归分析确定有统计学意义的指标。进一步使用受试者工作特征(ROC)曲线及曲线下面积(AUC)确定量化参考值。结果患者术后HO的总体发生率为61.4%(27/44)。单因素分析显示HO发病组与HO未发病组之间手术节段椎间隙高度丢失、椎体前缘骨赘形成和终板硬化差异均有统计学意义(均P<0.05),而logistic回归分析发现术前手术节段椎间隙高度和终板硬化是术后HO形成的独立危险因素[OR值(95%CI)为10.801(1.202~97.064)、37.870(1.581~907.237),均P<0.05],ROC曲线分析中,二者的AUC分别为0.822与0.792,基于“9分法”,二者边界值均为1.5。结论Bryan颈椎人工间盘置换术后HO发生率相对较高,且术前手术节段退变程度是其发生的关键因素。Objective To investigate parameters related to quantifying the amount of degeneration in preoperative patients to identify ideal indication of artificial cervical disc replacement(ACDR)in patient with a minimum of 10 years of follow-up data.Methods From January 2004 to August 2008,a total of 44 patients underwent single level Bryan cervical disk replacement performed by the same group of surgeons were involved in this retrospective study,and all of the patients in this group had at least 10 years of follow-up data.Heterotopic ossification(HO)was graded in radiographic images by using the McAfee classification.Preoperative degeneration of cervical spine was evaluated in radiographs based on a quantitative"9 points"scoring system.Univariate analysis and multifactor logistic regression were made to identify significant factors.To determine the cut-off points for the significant factors,a receiver operating characteristic(ROC)curve analysis was conducted.Results The incidence of HO in study group was 61.4%.Based on univariate analysis results,there were significant differences in the scores of disc height,the presence of anterior osteophytes and endplate sclerosis between the HO group and non-HO group(all P<0.05),and the indices were included in the multivariate analysis.According to the logistic regression results,disc height and endplate sclerosis were identified as the independent risk factors for HO(OR(95%CI):10.801(1.202-97.064),37.870(1.581-907.237),respectively,both P<0.05).ROC analysis showed the area under the curve(AUC)of disc height and endplate sclerosis were 0.822 and 0.792,respectively.According to the scoring system,the ROC curve indicated that both the optimal cutoff points were 1.5.Conclusion The incidence of postoperative HO is relatively high among the patients who had more than 10 years follow-up,and the amount of degeneration in the target level before surgery correlated with the incidence of HO.

关 键 词：颈椎 颈椎人工间盘置换术 异位骨化 适应证 退变 

分 类 号：R687.3[医药卫生—骨科学]