基于症状严重程度分层的脊髓型颈椎病患者颈前路椎间盘切除减压融合术后结局的研究  

A study of postoperative outcomes of anterior cervical discectomy and fusion in CSM patients stratified by different symptom severity

作　　者：王玉强[1] 牛慧霞[2] 刘宏建[1] 张书豪[1] 赵耀[1] 杨浩[1] 张敏[1] 王卫东[1] 王利民[1] 刘屹林[1] Wang Yuqiang;Niu Huixia;Liu Hongjian;Zhang Shuhao;Zhao Yao;Yang Hao;Zhang Min;Wang Weidong;Wang Limin;Liu Yilin(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052 [2]郑州大学第一附属医院神经内科,郑州450052

出　　处：《中华实验外科杂志》2024年第4期846-851,共6页Chinese Journal of Experimental Surgery

基　　金：河南省科技厅重点研发与推广专项(222102310489);河南省高等学校重点科研项目计划(24A320068)。

摘　　要：目的探讨不同症状严重程度的脊髓型颈椎病(CSM)患者接受颈前路椎间盘切除减压融合术(ACDF)的临床结果和社会功能改善情况。方法前瞻性收集2017年1月至2023年1月郑州大学第一附属医院骨科因CSM行初次ACDF(单节段或双节段)手术的患者198例,根据患者术前日本骨科协会(JOA)量表评分将其分为轻度组(>13分,52例)、中度组(9~13分,87例)和重度组(<9分,59例)。采用颈部疼痛(NP)和手臂疼痛(AP)视觉模拟评分(VAS)评价疼痛程度;术后采用JOA量表、颈椎活动障碍指数(NDI)、物理成分得分(PCS)和心理成分得分(MCS)评价患者神经功能。采用最小临床重要差异(MCID)评价患者临床改善情况;采用社会功能满意度调查问卷了解患者术后社会功能恢复的满意程度,计算重返工作率(RTWR),采用方差分析或χ^(2)检验或Fisher确切概率法等对数据进行统计学分析。结果与术前比较,3组患者术后6个月和术后1年JOA评分升高[术前:(14.7±1.3)、(10.9±2.6)、(7.1±3.2),术后6个月:(15.9±1.4)、(13.8±1.6)、(12.3±2.9),术后1年:(16.1±1.2)、(14.4±1.9)、(12.9±2.7),F时间=76.724,P<0.05],NDI降低[术前:(23.1±16.3)、(28.1±16.9)、(46.3±18.5),术后6个月:(10.4±5.6)、(15.3±8.2)、(23.4±15.7),术后1年:(9.1±4.8)、(12.7±6.6)、(18.1±9.9),F时间=109.747,P<0.05],NP-VAS[术前:(3.5±1.6)、(3.7±1.4)、(3.6±1.5),术后6个月:(1.4±0.3)、(1.3±0.4)、(1.6±0.5),术后1年:(0.9±0.4)、(1.1±0.3)、(1.1±0.4),F时间=47.381,P<0.05]、AP-VAS[术前:(2.9±2.0)、(3.0±1.8)、(2.8±1.9),术后6个月:(0.9±0.7)、(1.3±0.6)、(1.4±0.6),术后1年:(0.8±0.6)、(0.9±0.6)、(1.1±0.5),F时间=43.774,P<0.05]评分降低,PCS升高[术前:(41.9±15.4)、(33.8±10.6)、(26.7±9.8),术后6个月:(49.3±17.2)、(44.6±15.8)、(37.9±12.6),术后1年:(49.9±19.1)、(47.4±17.1)、(41.3±16.0),F时间=96.219,P<0.05];除轻度组外,中度组和重度组术后6个月和术后1年MCS较术前升高[术前:(45.1±10.3)、(39.7±Objective To explore clinical outcomes and improved social function on patients with different severity cervical spondylotic myelopathy(CSM)who underwent anterior cervical discectomy and fusion(ACDF).Methods A total of 198 patients undergoing initial ACDF(single or double level)for CSM in the Department of Orthopaedics in the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2023 were prospectively collected.According to Japanese orthopaedic association(JOA)scores,the patients were stratified into three groups:mild(>13 points,52 cases),moderate(9-13 points,87 cases)and severe(<9 points,59 cases).Neck pain(NP)and arm pain(AP)were evaluated by visual analogue scale(VAS).Postoperative neurological function was evaluated by JOA scales,neck disability index(NDI),physical component score(PCS),and mental component score(MCS).Minimal clinically important difference(MCID)was used to evaluate the clinical improvement for patients.The social function satisfaction questionnaire was used to investigate the satisfaction degree of social function recovery after operation.Calculating the return to work rate(RTWR)was used to evaluate social function.The data were statistically analyzed by ANOVA orχ^(2) test or Fisher exact probability method.Results JOA scores[preoperative:(14.7±1.3),(10.9±2.6),(7.1±3.2),6 months after surgery:(15.9±1.4),(13.8±1.6),(12.3±2.9),1 year after surgery:(16.1±1.2),(14.4±1.9),(12.9±2.7),Ftime=76.724,P<0.05]and PCS[preoperative:(41.9±15.4),(33.8±10.6),(26.7±9.8),6 months after surgery:(49.3±17.2),(44.6±15.8),(37.9±12.6),1 year after surgery:(49.9±19.1),(47.4±17.1),(41.3±16.0),Ftime=96.219,P<0.05]were increased,NDI[preoperative:(23.1±16.3),(28.1±16.9),(46.3±18.5),6 months after surgery:(10.4±5.6),(15.3±8.2),(23.4±15.7),1 year after surgery:(9.1±4.8),(12.7±6.6),(18.1±9.9),Ftime=109.747,P<0.05],NP-VAS[preoperative:(3.5±1.6),(3.7±1.4),(3.6±1.5),6 months after surgery:(1.4±0.3),(1.3±0.4),(1.6±0.5),1 year after surgery:(0.9±0.4),(1.1±0.3),(1.1±0.

关 键 词：椎间盘切除术 脊髓型颈椎病 颈前路椎间盘切除减压融合术 神经功能 

分 类 号：R687.3[医药卫生—骨科学]