一期后路椎管扩大减压术治疗颈椎多节段后纵韧带骨化症的效果及失衡风险分析  

Analysis of the Effect and Risk of One-Stage Posterior Spinal Canal Enlargement and Decompression in the Treatment of Multi-Segmental Ossification of Cervical Posterior Longitudinal Ligament

作　　者：李金生 张桐 何雨佳 LI Jinsheng;ZHANG Tong;HE Yujia(The People's Hospital of Qitaihe,Qitaihe 154600,Heilongjiang China)

机构地区：[1]七台河市人民医院,黑龙江七台河154600

出　　处：《中国中医骨伤科杂志》2024年第10期81-86,89,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨一期后路椎管扩大减压术治疗颈椎多节段后纵韧带骨化症(OPLL)颈椎矢状位参数变化及失衡风险。方法:回顾性分析2020年1月至2022年9月收治的96例颈椎多节段后纵韧带骨化症患者的临床资料。于术前及术后12个月分别评估患者的疼痛视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分和颈椎功能障碍指数(NDI)。收集患者术前、术后即刻及术后12个月随访时的颈椎矢状位相关参数。根据术后12个月C_(2~7)矢状位轴向距离(SVA)中位数将96例患者分为平衡组(C_(2~7) SVA≤41.20 mm)和失衡组(C_(2~7) SVA>41.20 mm),对两组患者的一般临床资料、影像学矢状位参数等指标进行组间比较,采用贝叶斯Cox比例风险回归确定患者术后出现颈椎矢状位失衡的影响因素。结果:96例患者随访12个月,与术前相比,术后即刻及术后12个月的T_(1)倾斜角(T_(1)S)、胸廓入口角(TIA)、C_(2~7)Cobb角均明显增大,C_(2~7)矢状位轴向距离明显减小(P<0.05)。术前及术后12个月、手术前后变化量(Δ)均表现为:T_(1)倾斜角、胸廓入口角、C_(2~7) Cobb角相互正相关(P<0.05),C_(2~7)矢状位轴向距离与T_(1)倾斜角、胸廓入口角、C_(2~7) Cobb角均呈明显负相关(P<0.05)。术后12个月,15例患者出现颈椎矢状位失衡(失衡组),其余81例维持正常(平衡组)。Cox回归多因素分析结果显示:术前C_(2~7)矢状位轴向距离大(风险比=1.05,95%CI=1.03~1.08)、混合型后纵韧带骨化症(风险比=1.26,95%CI=1.10~1.75)、术前颈椎功能障碍指数(NDI)高(风险比=13.20,95%CI=6.01~29.85)、术前JOA评分低(风险比=0.08,95%CI=0.03~0.12)是术后颈椎矢状位失衡的危险因素(P<0.05)。结论:一期后路椎管扩大减压术可改善脊髓神经功能和颈椎功能,减轻患者疼痛,对后纵韧带骨化症患者有明显疗效。颈椎矢状位相关参数与术后颈椎矢状位失衡风险相关。Objective:To explore the changes of cervical sagittal parameters and risk factors of imbalance in the treatment of cervical multi-segmental ossification of posterior longitudinal ligament(OPLL) by one-stage posterior spinal canal enlargement and decompression.Methods:The clinical data of 96 patients with multi-segmental cervical vertebra OPLL treated from January 2020 to September 2022 were collected retrospectively.Japanese orthopaedic association(JOA) score,neck disability index(NDI) and visual analogue scale(VAS) score were evaluated before operation and 12 months after operation.The anterior and lateral cervical X-ray films were collected before operation,immediately after operation and 12 months after operation,and the related parameters of cervical sagittal position were measured.According to the median of C_(2-7) SVA 12 months after operation,96 patients were divided into balanced group(C_(2-7) SVA≤41.2 mm) and unbalanced group(C_(2-7) SVA>41.2 mm).The general clinical data and imaging sagittal parameters of the two groups were compared.Bayesian Cox proportional hazard regression was used to determine the influencing factors of cervical sagittal imbalance after operation.Results:96 patients were followed up for 12 months.Immediately after operation and 12 months after operation,T_(1) slope(T_1S),thoracic inlet angle(TIA) and C_(2-7) Cobb angle were significantly increased,while C_(2-7) SVA at C_(2-7) sagittal position was significantly decreased compared with those before operation.The changes before operation,12 months after operation and before and after operation showed that T_1S,TIA and C_(2-7) Cobb angle were positively correlated with each other,while C_(2-7) SVA was negatively correlated with T_1S,TIA and C_(2-7) Cobb angle.12 months after operation,15 patients had cervical sagittal imbalance(imbalance group),and the other 81 patients remained normal(balance group).The results of Cox regression multivariate analysis showed that preoperative high C_(2-7) SVA(hazard ratio=1.05,95%CI=1.03■1.08),mix

关 键 词：颈椎 后纵韧带骨化症 一期后路椎管 影像学评估 颈椎矢状位 

分 类 号：R687.3[医药卫生—骨科学]