多节段颈椎后纵韧带骨化症行全椎板减压术后疗效的影响因素  

Influencing factors of efficacy after total laminectomy in patients with multi-segment cervical ossification of posterior longitudinal ligment

作　　者：董征[1] 未东兴[1] 段大波[1] DONG Zheng;WEI Dong-xing;DUAN Da-bo(Department of Orthopedics,Jinzhou Central Hospital,Jinzhou Liaoning 121000,China)

机构地区：[1]锦州市中心医院骨科,辽宁锦州121000

出　　处：《局解手术学杂志》2023年第7期617-620,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(30772190)。

摘　　要：目的探讨多节段颈椎后纵韧带骨化症(OPLL)患者行全椎板减压术后疗效的影响因素。方法回顾性分析我院行全椎板减压术治疗的68例多节段OPLL患者的临床资料,根据术后1年日本骨科协会(JOA)评分改善率分为疗效优组(42例)及疗效差组(26例)。采用单因素分析和多因素Logistic回归分析疗效的影响因素。结果单因素分析显示,年龄、病程、糖尿病史、术前脊髓压迫程度、术前颈椎曲度、术前MRI脊髓高信号等与多节段OPLL患者行全椎板减压术后疗效有关(P<0.05)。多因素Logistic回归分析显示,高龄(OR:1.071,95%CI:1.009~1.137)、病程长(OR:4.438,95%CI:1.885~10.029)、糖尿病史(OR:3.750,95%CI:1.163~12.094)、术前脊髓重度压迫(OR:16.800,95%CI:3.860~73.122)、术前MRI脊髓高信号(OR:8.028,95%CI:2.629~24.511)等为多节段OPLL患者行全椎板减压术后疗效差的独立危险因素(P<0.05),而术前颈椎曲度(OR:0.757,95%CI:0.618~0.928)为多节段OPLL患者行全椎板减压术后疗效优的独立保护因素(P<0.05)。结论高龄、病程长、糖尿病史、术前脊髓重度压迫、术前MRI脊髓高信号等为多节段OPLL患者行全椎板减压术后疗效不佳的独立危险因素,而良好的术前颈椎曲度对提升疗效具有积极的作用。Objective To investigate the influencing factors of efficacy after total laminectomy in patients with multi-segment cervical ossification of posterior longitudinal ligment(OPLL).Methods The clinical data of 68 patients with multi-segment OPLL treated by total laminectomy in our hospital were retrospectively analyzed,and they were divided into the group with excellent efficacy(42 cases)and the group with poor efficacy(26 cases)according to the improvement rate of the Japanese Society of Orthopedics(JOA)score 1 year after the surgery.The univariate analysis and multivariate Logistic regression analysis were used to explore the influencing factors related to the efficacy.Results The univariate analysis showed that age,course of disease,history of diabetes,preoperative spinal cord compression,preoperative cervical spine curvature,and high signal intensity of spinal cord on preoperative MRI were related to the efficacy after total lamina decompression in patients with multi-segment OPLL(P<0.05).Multivariate Logistic regression analysis showed that advanced age(OR:1.071,95%CI:1.009 to 1.137),long course of disease(OR:4.438,95%CI:1.885 to 10.029),history of diabetes(OR:3.750,95%CI:1.163 to 12.094),preoperative severe spinal cord compression(OR:16.800,95%CI:3.860 to 73.122),and high signal intensity of spinal cord on preoperative MRI(OR:8.028,95%CI:2.629 to 24.511)were the independent risk factors of poor efficacy after total lami-nectomy in patients with multi-segment OPLL(P<0.05),and preoperative cervical curvature(OR:0.757,95%CI:0.618 to 0.928)was an independent protective factor with excellent efficacy after total laminectomy in patients with multi-segment OPLL(P<0.05).Conclusion The advanced age,long course of disease,history of diabetes,preoperative severe spinal cord compression,and high signal intensity of spinal cord on preoperative MRI are the independent risk factors for poor efficacy after total laminectomy in patients with multi-segment OPLL,and the good preoperative cervical curvature has a positive effect

关 键 词：多节段 颈椎后纵韧带骨化症 全椎板减压术 疗效 影响因素 

分 类 号：R681.5[医药卫生—骨科学]