多节段颈椎前路术后颈椎前凸角丢失的危险因素分析  

Risk factors associated with loss of lordosis after multilevel anterior cervical surgery

作　　者：王宇 李翔宇 刘承鑫 孔超 鲁世保[1] Wang Yu;Li Xiangyu;Liu Chengxin;Kong Chao;Lu Shibao(Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《首都医科大学学报》2022年第1期149-155,共7页Journal of Capital Medical University

摘　　要：目的探索多节段颈椎前路术后颈椎前凸角(cervical lordosis,CL)丢失的危险因素。方法对105名行多节段颈椎前路手术的患者进行回顾性研究,测量颈椎深部椎旁肌的横截面积(cross-sectional area,CSA),测量患者术前术后CL、T1倾斜角(T1 slope,T1S)、C2~7矢状垂直距离(cervical sagittal vertical axis,cSVA),采用日本矫形外科协会(Japanese Orthopedic Association,JOA)评分恢复率来评价颈椎术后治疗效果。根据患者术后CL的变化,将患者分为前凸角增加组、前凸角稳定组和前凸角丢失组。结果CL的变化(△CL)与术前CL以及术前T1S呈负相关,与深部椎旁屈曲肌CSA之间呈正相关。前凸角丢失组术前T1S更大,深部椎旁屈曲肌及后伸肌CSA更小;前凸角增加组术前CL更小,cSVA更大,深部椎旁屈曲肌CSA更大。多元逐步回归分析发现术前较大的T1S以及较小的颈椎深部椎旁屈曲肌CSA是术后CL丢失的危险因素。结论术前较大的T1S以及较小的颈椎深部椎旁屈曲肌的CSA是多节段颈椎前路手术术后颈椎前凸角丢失的危险因素。Objective To evaluate risk factors associated with the loss of lordosis after multilevel anterior cervical surgery.MethodsWe retrospectively reviewed 105 patients with cervical myelopathy who received anterior cervical surgery.Preoperative deep paraspinal muscles cross-sectional area(CSA)was evaluated.Cervical alignment assessment included cervical lordosis(CL),T1 slope(T1S),and cervical sagittal vertical axis(cSVA).The recovery rate of the Japanese Orthopedic Association(JOA)score was used to evaluate the effect of cervical spine surgery.The alignment change(△CL)was used to assign groups for patients:lordosis loss group,lordosis kept group,and lordosis gain group.Results Pearson correlation analysis suggested the alignment changes negatively correlated with preoperative CL and preoperative T1S,and positively with deep flexor CSA.Comparisons among three alignment change groups suggested that a larger T1S,smaller extensor CSA,and smaller flexor CSA were related with lordosis loss.A smaller CL and larger cSVA were related with lordosis gain.The result of multivariate stepwise logistic regression showed that a larger preoperative T1S and a smaller deep flexor CSA were significant risk factors of lordosis loss.Conclusion The results of the present study demonstrated that a larger T1 slope and a smaller deep flexor CSA highly predicted the loss of lordosis for patients with multilevel anterior cervical surgery.

关 键 词：颈椎前凸角 多节段颈椎前路手术 颈椎椎旁肌横截面 T1倾斜角 

分 类 号：R681[医药卫生—骨科学]