对颈椎椎旁肌脂肪浸润与颈椎病患者颈椎前路Hybrid术后矢状面平衡参数关系的分析  

Effect of fatty infiltration of the cervical paraspinal muscle on sagittal balance parameters after anterior cervical Hybrid surgery:a retrospective analysis

作　　者：李益[1] 丁琛[1] 何俊波 王贝宇[1] 孟阳[1] 吴廷奎 洪瑛[1] 刘浩[1] Li Yi;Ding Chen;He Junbo;Wang Beiyu;Meng Yang;Wu Tingkui;Hong Ying;Liu Hao(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《骨科临床与研究杂志》2023年第2期110-117,共8页Journal Of Clinical Orthopedics And Research

基　　金：国家自然科学基金(82172522)~~。

摘　　要：目的 探讨颈椎椎旁肌脂肪浸润对颈椎病患者颈椎前路Hybrid术后矢状面平衡参数的影响。方法 对2011年1月至2020年7月四川大学华西医院骨科行双节段Hybrid手术(置换节段为C5/6)的颈椎病患者27例的临床资料进行回顾性分析。收集全部患者的年龄、性别分布、体质量指数(BMI)、手术融合节段、手术时间、术中失血量和随访时间等一般临床资料和术中指标;采用JOA评分、NDI和VAS评分对术后患者临床症状改善进行评估;通过颈椎侧位及功能位X线测量患者颈椎矢状面平衡参数,包括颈椎曲度、矢状面垂直轴偏距、融合节段脊柱功能单位(FSU)Cobb角、置换节段FSU的Cobb角、置换节段Cobb角、C2-7节段活动度(ROM)和置换节段ROM;利用术前颈椎MRI T2加权成像轴位像C5/6层面评估胸锁乳突肌、颈长肌和颈深伸肌肌群的横截面积,同时评估C5椎体面积和椎旁肌脂肪浸润程度。依据Goutallier分级法对椎旁肌脂肪浸润程度进行分级,并以全部患者椎旁肌脂肪浸润分级中位数1.5级为划分标准将患者分为少脂组(Goutallier 0~1.5级)和多脂组(Goutallier 2~4级)。对两组患者的一般临床资料和术中指标进行比较;对两组患者术前与术后的JOA评分、NDI和VAS评分以及各项矢状面平衡参数进行组内和组间比较。使用SPSS 26.0软件对数据进行统计学分析;P<0.05为差异有统计学意义。结果 两组患者的年龄、性别分布、BMI、融合节段与置换节段的位置关系、手术时间、术中失血量以及随访时间等差异均无统计学意义(均P>0.05)。两组患者术后JOA评分、NDI和VAS评分均较术前有显著改善(均P<0.05),但组间差异均无统计学意义(均P>0.05)。术前与末次随访时,少脂组置换节段FSU的Cobb角均明显大于多脂组,差异均有统计学意义(均P<0.05),其他矢状面平衡参数组间差异均无统计学意义(均P>0.05)。末次随访少脂组患者置换节段Cobb角和�Objective To investigate the effect of fatty infiltration of the cervical paraspinal muscle on sagittal balance parameters after anterior cervical Hybrid surgery and the correlation between fatty infiltration and cross-sectional area. Methods Clinical data of 27 patients undergoing 2-level Hybrid surgery(C5/6 was the replacement segment) in the Department of Orthopaedics, West China Hospital of Sichuan University from January 2011 to July 2020 were retrospectively analyzed. General clinical and intraoperative data such as age, sex, body mass index(BMI), fusion segments, operation time, intraoperative blood loss and follow-up duration were recorded. The Japanese Orthopaedic Association(JOA) score, neck disability index(NDI) and visual analogue scale(VAS) were used to assess the clinical symptoms before and after surgery. The cervical sagittal balance parameters including Cobb’s angle, vertical axial deviation of sagittal plane, Cobb’s angle of functional spinal unit(FSU) of fusion segments, Cobb’s angle of FSU of replacement segments, Cobb’s angle of replacement segments, range of motion(ROM) of C2-7 and ROM of replacement segments of cervical spine were assessed by X-ray. The cross-sectional area of the cervical paraspinal muscle and the degree of fatty infiltration in the C5/6 plane were quantified on T2-weighted axial MRI. The degree of fatty infiltration was measured according to the Goutallier classification and the final degree was the average value of both sides. All patients were divided into 2 groups based on the median value of Goutallier grade(grade 1.5):the less fatty group(Goutallier grade 0-1.5) and the more fatty group(Goutallier grade 2-4). The general clinical data and intraoperative data were compared between the 2 groups. The correlation between the degree of fatty infiltration and sagittal balance parameters and cross-sectional area of the cervical paraspinal muscle were analysed. Results There were no statistically significant difference between the 2 groups in terms of age, sex, BMI,

关 键 词：椎旁肌 颈椎 脂肪组织 脊柱融合术 全椎间盘置换 姿势平衡 活动范围 关节 磁共振成像 放射摄影术 

分 类 号：R687.3[医药卫生—骨科学]