颈椎前路椎间盘切除融合术后颈长肌、颈伸肌变化与临床疗效的相关性  

Correlation between changes of cervical longus and cervical extensor muscles and clinical efficacy after anterior cervical discectomy and fusion

作　　者：杨帅[1] 郭柱[1] 相宏飞[1] 刘畅[1] 朱有福 郭昭阳 张国庆[1] 吴晓淋 王岩[1] 陈伯华[1] Yang Shuai;Guo Zhu;Xiang Hongfei;Liu Chang;Zhu Youfu;Guo Zhaoyang;Zhang Guoqing;Wu Xiaolin;Wang Yan;Chen Bohua(Department of Spine Surgery,Affiliated Hospital of Qingdao University,Qindao 266100,China)

机构地区：[1]青岛大学附属医院脊柱外科,青岛266100

出　　处：《中华骨科杂志》2022年第2期111-120,共10页Chinese Journal of Orthopaedics

基　　金：泰山学者青年专家工程(tsqn201909190);国家重点研发计划(2019YFC0121404);青岛市应用基础研究计划(19-6-2-51-cg);国家自然科学基金(81802190,81772412)。

摘　　要：目的评估颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)后颈长肌、颈伸肌的容积变化,以及其与临床疗效的相关性。方法回顾性分析2013年1月至2018年12月接受单节段ACDF手术治疗的脊髓型颈椎病患者57例,随访时间为(23.0±4.8)个月(范围16~34个月)。所有纳入对象均于术前1周内和术后3、12个月及末次随访时进行MR检查,在轴位MRI T2WI测量C2~C7各椎间盘水平的颈长肌截面积(axial section of longus colli cross section area,AxCSA)、长短径线比值(ratio of long and short diameter line,RLS),并依据层厚计算颈长肌容积。同时测量相同层面包括多裂肌、颈半棘肌、头半棘肌、头夹肌、颈夹肌在内的颈伸肌截面积(cervical extensor cross-sectional area,CESA),并将CESA与相应椎体截面积(vertebra body area,VBA)的比值作为颈伸肌容积进行分析,即CESA/VBA。术后3、12个月及末次随访时采用疼痛视觉模拟评分(visual analog scale,VAS)评估轴性疼痛程度,改良日本矫形协会评分(modified Japanese Orthopedic Association score,mJOA)及颈部功能障碍指数(neck disability index,NDI)评估颈椎功能状态。分析手术前后及随访期间颈长肌、颈伸肌的形态学变化,并与VAS、mJOA及NDI进行相关性分析。结果手术节段AxCSA在术后第3、12个月及末次随访时较术前(140.84±19.51)mm2均有减小,差异有统计学意义(F=24.113,P<0.05),分别减少至(117.74±17.15)mm2(t=6.714,P<0.05)、(116.37±18.67)mm2(t=6.841,P<0.05)和(116.27±18.65)mm2(t=6.873,P<0.05),较术前分别减少16.40%、17.37%和17.45%;RLS则较术前1.97±0.67均有增加,差异有统计学意义(F=22.612,P<0.05),分别增加至2.73±0.60(t=6.380,P<0.05)、2.82±0.64(t=6.926,P<0.05)和2.74±0.62(t=6.368,P<0.05),较术前分别增加38.58%、43.15%和39.09%;颈长肌容积均较术前(8853.48±458.65)mm3均有减小,差异有统计学意义(F=64.511,P<0.05),分别减少至(7834.53±461.59)mm3(t=11.822,P<0.05)、(7926.42±45Objective To evaluate the volume changes of cervical longus and cervical extensor after anterior cervical discectomy and fusion(ACDF),and the correlation with the clinical efficacy of patients.Methods All of 57 patients with cervical spondylotic myelopathy who underwent single-segment ACDF surgery from January 2013 to December 2018 were analyzed.The follow-up time was 23.0±4.8 months(range 16-34 months).All included subjects underwent MR examination within 1 week before operation and 3rd,12th months after operation and at the last follow-up.The axial section cross section area(AxCSA)of the cervical longus and the ratio of length to short diameter line(RLS)at the level of each disc of C2-C7 were measured on the axial T2WI.Calculate the volume of the cervical longus based on the layer thickness.At the same time,measure the cervical extensor cross-sectional area(CESA)of the same level including the multifidus,cervical semispinous muscle,semispinous head,splinter head,and cervical splinter muscles,and compare CESA with the corresponding vertebral cross-sectional area(VBA).The ratio is analyzed as the volume of the neck extensor muscle,namely CESA/VBA.At the 3rd and 12th months after operation and at the last follow-up,the axial pain was assessed by visual analogue scale(VAS)for assessing pain,and the modified Japanese Orthopedic Association score(mJOA)and the neck dysfunction index(NDI)were used to assess the functional status of the cervical spine.Analyze the morphological changes of thecervical longus and extensor cervical muscles before and after the operation and during the follow-up period,and analyze the correlation with VAS,mJOA,and NDI.Results Compared with the preoperative period,the average AxCSA of the surgical segment decreased at the 3rd and 12th months after the operation and at the last follow-up.The difference was statistically significant(F=24.113,P<0.05),which was changed from 140.84±19.51 mm2 respectively reduce to 117.74±17.15 mm2(t=6.714,P<0.05),116.37±18.67 mm2(t=6.841,P<0.05)and 116.27±18.

关 键 词：颈椎 椎间盘切除术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]