颈椎病两种前路术式对矢状位平衡的影响  

Effect of two types of anterior operation on sagittal balance in cervical spondylosis

作　　者：刘飞飞 任莉荣 阮玉山 丁凯 李忠杰 李绍波 LIU Fei-fei;REN Li-rong;RUAN Yu-shan;DING-Kai;LI Zhong-jie;LI Shao-bo(Department of Spinal Surgery,the First Affiliated Hospital of Dali University,Dali,Yunnan 671000,China)

机构地区：[1]大理大学第一附属医院脊柱外科,云南大理671000

出　　处：《颈腰痛杂志》2023年第6期950-954,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：云南省教育厅科学研究基金项目(编号:2021J0388);云南省教育厅科学研究基金项目(编号:2023J0904);大理大学第一附属医院学科建设骨干项目(编号:DFYGG2022-28)。

摘　　要：目的对比颈椎前路两种术式的临床疗效及对颈椎矢状位平衡的影响。方法回顾性分析2018年1月~2020年1月在大理大学第一附属医院脊柱外科因颈椎病行颈前路手术的53例患者,将其分为两组,A组25例(行单节段ACCF术),B组28例(行两相邻节段ACDF术),测量手术前及术后末次随访时颈椎侧位X线片上的相关参数,对以上数据进行统计学分析。结果两组患者C_(2-7)Cobb角、手术节段Cobb角(segment Cobb angle,SCobb)、C_(2-7)矢状位垂直距离(C_(2-7)sagittal vertical axis,C_(2-7)SVA)、T_(1)倾斜角(T_(1)-Slope,T_(1)S)、颈倾斜角(neck tilt,NT)的手术前后组内比较,差异有统计学意义(P<0.05);两组间比较,末次随访时的C_(2-7)SVA组间差异有统计学意义(P<0.05),术前及末次随访时的T_(1)S组间差异有统计学意义(P<0.05);两组术前、术后末次随访时的组内VAS评分、NDI指数比较,差异有统计学意义(P<0.05)。相关性分析显示,C_(2-7)Cobb角与SCobb角(r=0.644,P<0.05)和T_(1)S(r=0.417,P<0.05)呈正相关,与C_(2-7)SVA(r=-0.493,P<0.05)呈负相关。结论ACCF和ACDF两种前路术式均通过改变矢状位平衡使颈椎病患者获得良好的临床疗效,两种术式对颈椎矢状位平衡的改变效果相似,C_(2-7)Cobb角与其他颈椎矢状位参数有相关性。Objective To compare the clinical efficacy of the two anterior cervical surgery methods and the effect on the sagittal balance of cervical spine.Methods A retrospective analysis was performed on the clinical data of 53 cases of cervical spondylosis patients admitted to the Department of Spine Surgery in our hospital from January,2018 to January,2020.There were 25 cases in Group A,who had an operation on single segment ACCFand 28 cases in Group B,who had an operation on two adjacent segments ACDF.The relevant parameters on lateral radiographs of cervical spine were measured before surgery and at the last follow-up after surgery,and the above data were statistically analyzed.Results There were statistically significant differences in C_(2-7)Cobb angle,SCobb,C_(2-7)SVA,T_(1)S and NT between the two groups before and after surgery(P<0.05).There was statistically significant difference in C_(2-7)SVA between the two groups at the last follow-up(P<0.05),and there was statistically significant difference in T_(1)s between the two groups before surgery and at the last follow-up(P<0.05).There were statistically significant differences in VAS score and NDI index between the two groups in preoperative and final postoperative follow-up(P<0.05).C_(2-7)Cobb angle was positively correlated with SCobb angle(r=0.644,P<0.05)and T_(1)S(r=0.417,P<0.05),and negatively correlated with C_(2-7)SVA(r=-0.493,P<0.05).Conclusion Both ACCF and ACDF anterior surgery methods can achieve good clinical efficacy in patients with cervical spondylosis by changing sagittal balance.The alteration effect of both methods on cervical sagittal balance is similar,and C_(2-7)Cobb angle is correlated with other cervical sagittal parameters.

关 键 词：颈椎病 ACCF ACDF 矢状位平衡 

分 类 号：R687.3[医药卫生—骨科学]