脊髓型颈椎病患者行颈后路椎板成形术后继发颈椎曲度丢失的风险因素  

Risk factors for secondary cervical curvature loss after posterior laminoplasty in patients with cervical spondylotic myelopathy

作　　者：孟宪志[1] 韩新勇 李文龙 刘殿鹏[1] MENG Xian-zhi;HAN Xin-yong;LI Wen-long;LIU Dian-peng(The Sixth People’s Hospital of Anyang,Anyang,Henan 455000,China)

机构地区：[1]河南省安阳市第六人民医院,河南安阳455000

出　　处：《颈腰痛杂志》2024年第2期286-290,295,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨脊髓型颈椎病患者行颈后路单开门椎板成形(cervical open-door expansive laminoplasty,LAMP)手术后的颈椎曲度丢失情况,并分析其相关因素。方法回顾性分析该院骨科于2018年1月~2020年1月开展LAMP手术(开门侧均采用微型钛板固定)的82例脊髓型颈椎病患者资料,评价患者术前、术后2年时的VAS评分、mJOA评分和改善率,并观察患者术前、术后2年时的C1-2Cobb角、C_(2-7)Cobb角、C_(2-7)屈曲和伸展ROM、C_(2-7)矢状位垂直距离(sagittal vertical axis,SVA)变化情况。对上述影像学指标之间的相关性、上述指标与VAS评分和mJOA评分改善程度的相关性,均采用Spearman相关性分析;采用多元线性回归分析,确定LAMP术后C_(2-7)Cobb角、C_(2-7)ROM减少和C_(2-7)SVA增加的风险因素。结果(1)与术前相比,所有患者LAMP术后2年的VAS评分显著降低(P<0.05)、mJOA评分显著升高(P<0.05),mJOA改善率达到(50.5±10.5)%;术后2年的C_(2-7)Cobb角和C_(2-7)ROM均显著减少,而C_(2-7)SVA显著增加(P<0.05)。(2)Spearman相关性分析显示,术后C_(2-7)Cobb角与T_(1)斜率和C_(2-7)屈曲ROM呈正相关性(r=0.223,r=0.386);术后C_(2-7)SVA值与C1-2Cobb角和T_(1)斜率呈正相关性(r=0.295,r=0.491),与术后C_(2-7)屈曲ROM呈负相关性(r=-0.325)。术后VAS改善程度、mJOA改善率与C_(2-7)Cobb角、C_(2-7)屈曲ROM和C_(2-7)SVA的变化值均无明显相关性(P>0.05)。(3)多元线性回归分析显示,术前T_(1)斜率越大,则术后C_(2-7)Cobb角减少越明显(β=0.331;P=0.007);术前C_(2-7)伸展ROM越大,则术后C_(2-7)Cobb角的减少越轻微(β=-0.312;P=0.022)。结论多节段脊髓型颈椎病患者行LAMP手术后,可出现颈椎曲度丢失、活动度减少和颈椎重心位置前移等变化,但尚未对术后早期疗效造成明显影响。术前颈椎伸展能力越大,术后颈椎曲度丢失越少;术前T_(1)斜率越大,则术后颈椎曲度丢失越明显。Objective To investigate the loss of cervical curvature in patients with cervical spondylotic myelopathy after cervical open-door expansive laminoplasty(LAMP),and analyze the related factors.Methods Retrospective analysis was performed on the clinical data of 82 patients with cervical spondylotic myelopathy who underwent LAMP operation in our orthopedics department from January 2018 to January 2020(the door opening side was fixed with micro titanium plate).The VAS score,mJOA score and improvement rate of the patients before and two years after the operation were evaluated.The changes in C 1-2 Cobb angle,C_(2-7) Cobb angle,C_(2-7) flexion and extension ROM C_(2-7) sagittal vertical axis(SVA)were observed.Spearman correlation analysis was used to analyze the correlation between the above imaging indexes and the improvement of VAS score and mJOA score.Multivariate linear regression analysis was used to determine the risk factors of C_(2-7) Cobb angle,C_(2-7) ROM reduction and C_(2-7) SVA increase after LAMP.Results①Compared with preoperation,the VAS score of all patients two years after LAMP was significantly lower(P<0.05),the mJOA score was significantly higher(P<0.05),and the improvement rate of mJOA was(50.5±10.5)%.The C_(2-7) Cobb angle and C_(2-7) ROM decreased significantly two years after operation,while the C_(2-7) SVA increased significantly(P<0.05).②Spearman correlation analysis showed that the postoperative C_(2-7) Cobb angle was positively correlated with T_(1) slope and C_(2-7) flexion ROM(r=0.223,r=0.386).Postoperative C_(2-7) SVA values were positively correlated with C 1-2 Cobb angle and T_(1) slope(r=0.295,r=0.491),and negatively correlated with postoperative C_(2-7) flexion ROM(r=-0.325).There was no significant correlation between the improvement of VAS and mJOA and the changes of C_(2-7) Cobb angle,C_(2-7) flexion ROM and C_(2-7) SVA(P>0.05).③Multivariate linear regression analysis showed that the greater the preoperative T_(1) slope,the more significant the postoperative C_(2-7) Cobb angl

关 键 词：脊髓型颈椎病 颈后路单开门椎板成形术 颈椎曲度 后凸畸形 风险因素 

分 类 号：R681.5[医药卫生—骨科学]