术前K线倾斜角预测后纵韧带骨化症单开门术后疗效的可行性分析  

Feasibility Analysis of Predicting the Clinical Effect of Single Open-Door Laminoplasty in the Treatment of Ossification of the Posterior Longitudinal Ligament By the Preoperative K Line Tilt

作　　者：王春增 张建伟 胡孟子 韩猛[1] 张兆川[1] 李杰[1] 刘光旺[1] Wang Chunzeng;Zhang Jianwei;Hu Menzi;Han Meng;Zhang Zhaochuan;Li Jie;Liu Guangwang(Department of Orthopaedics,Xuzhou Central Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市中心医院脊柱外科,江苏徐州221000

出　　处：《实用骨科杂志》2023年第11期961-965,共5页Journal of Practical Orthopaedics

基　　金：徐州市引进临床医学专家团队项目(2019TD002)。

摘　　要：目的 探讨术前K线倾斜角预测单开门椎管扩大成形术治疗后纵韧带骨化症患者临床疗效的可行性。方法 回顾性分析2019年2月至2022年1月行颈椎后路单开门椎管扩大成形术治疗的52例K线阳性后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)患者资料,其中男35例,女17例;年龄47~76岁,平均(61.46±7.26)岁。统计患者术前日本骨科协会(Japanese orthopedic association,JOA)评分、术后1年随访时JOA评分。颈椎中立侧位X线片测量术前矢状面参数:K线倾斜角、C_(2~7)Cobb角、C_(2~7)矢状面轴向距离(C_(2~7) sagittal vertical axis,C_(2~7) SVA)、头部重心(center gravity of head,CGH)~C_(7)矢状面轴向距离(CGH~C_(7) SVA)、T_(1)倾斜角。根据术后1年时JOA评分改善中位数分为改善优良组和改善较差组,采用单因素方差分析判断矢状位参数与疗效之间的关系,采用Pearson分析检验参数间的相关性。将有统计学差异的颈椎参数作为自变量,将JOA评分作为因变量,行Logistic回归分析影响术后JOA改善率的危险因素。结果 所有患者的术后临床症状均得到改善。OPLL患者术前JOA评分为(7.38±0.89)分,术前C_(2~7)Cobb角(14.45±8.81)°,C_(2~7)SVA(15.31±4.57)mm,CGH~C_(7) SVA(16.37±5.23)mm,T_(1)倾斜角(26.43±5.65)°、K线倾斜角(12.77±1.49)°。根据术后1年随访时JOA评分改善情况分组显示:术前K线倾斜角、C_(2~7)SVA、CGH~C_(7) SVA与术后疗效密切相关(P<0.001、P=0.013、P=0.022);术前K线倾斜角与C_(2~7)SVA、CGH~C_(7) SVA呈正相关(r=0.411、0.831,P=0.004、0.023)。上述相关性指标经Logistic回归分析显示:影响OPLL单开门术后疗效的危险因素为术前K线倾斜角和术前CGH~C_(7) SVA(OR=1.673、1.522,P=0.024、0.033)。结论 OPLL患者术后疗效与术前K线倾斜角度有关,术前K线倾斜角较大,患者术后疗效较差。K线倾斜角可作为一种新的临床指标用于颈椎后路单开门术前预测OPLL患者术后疗效。Objective To explore the feasibility of predicting the clinical effect of single open-door laminoplasty in the treatment of ossification of the posterior longitudinal ligament by the preoperative K line tilt.Methods The data of52 patients with ossification of the posterior longitudinal ligament(OPLL) with positive K line who were treated by posterior cervical single-door laminoplasty from February 2019 to January 2022 were analyzed retrospectively.35 male and 17 female were included.The patients age from 47 to 76 years,with an average of(61.46±7.26)years.The score of the Japanese orthopedic association(JOA) before the operation and the JOA score at the one-year follow-up after the operation were recorded.The parameters of sagittal plane before operation were measured on the neutral lateral radiograph of cervical spine,which including K-line tilt,C_(2~7) Cobb angle,C_(2~7) sagittal vertical axis(C_(2~7) SVA),center gravity of head(CGH)~C_(7) sagittal axial distance(CGH~C_(7) SVA),T_(1) slope.According to the median JOA score 1year after surgery,patients were divided into good improvement group and poor improvement group.The preoperative K-line tilt and other sagittal plane parameters were used as independent variables.One-way analysis of variance and Logistic regression were used to analyze the risk factors affecting the postoperative JOA improvement rate.Results The clinical symptoms of all patients were improved.The preoperative C_(2~7) Cobb angle was(14.45±8.81)°,C_(2~7) SVA was(15.31±4.57)mm,CGH~C_(7) SVA was(16.37±5.23) mm,T_(1) slop was(26.43±5.65)°,K-line tilt was(12.77±1.49)° and preoperative JOA score of OPLL patients were(7.38±0.89) points.According to the improvement rate of JOA score at 1 year follow-up,the analysis of preoperative cervical sagittal parameters after grouping showed that the preoperative k-line tilt,preoperative C_(2~7) SVA,preoperative CGH~C_(7) SVA(P<0.001,P=0.013,P=0.022) were closely related to the postoperative efficacy,and the preoperative K-line tilt was positively corr

关 键 词：后纵韧带骨化症 K线倾斜角 单开门扩大成形术 颈椎矢状面参数 

分 类 号：R681.5[医药卫生—骨科学]