影响扩大颈椎管单开门成形疗效的相关因素  

Factors related to outcome of extended cervical opendoor laminoplasty

作　　者：田志康 梁啸[2] 王梓焜 张振宇 鲍勇钢 杨涛 孟纯阳[2] TIAN Zhi-kang;LIANG Xiao;WANG Zi-kun;ZHANG Zhen-yu;BAO Yong-gang;YANG Tao;MENG Chun-yang(Jining Medical College,Jining 272067,China;Department ofSpine Surgery,Affiliated Hospital,Jining Medical College,Jining 272007,China;Shandong First Medical University,Jinan 250024,China)

机构地区：[1]济宁医学院,山东济宁272067 [2]济宁医学院附属医院脊柱外科,山东济宁272007 [3]山东第一医科大学,山东济南250024

出　　处：《中国矫形外科杂志》2024年第19期1753-1757,共5页Orthopedic Journal of China

基　　金：山东省自然科学基金重点项目(编号:ZR2020KH010)。

摘　　要：[目的] 探讨椎管扩大成形术(expansive open-door laminoplasty,ELAP)治疗多节段脊髓型颈椎病疗效的相关因素。[方法] 2020年7月—2023年6月因多节段脊髓型颈椎病行ELAP手术治疗的患者196例,采用单项因素比较和二元多因素逻辑回归分析影响神经功能恢复率的相关因素。[结果] 神经功能恢复率优良组149例(恢复率≥50%),占76.0%,不良组47例(恢复率<50%),占24.0%。单因素分析显示,不良组年龄[(62.2±8.8)岁vs (56.3±10.2)岁,P<0.001]、BMI[(27.0±2.9) kg/m^(2)vs (24.3±2.8) kg/m^(2),P<0.001]、高血压病占比[例(%),24 (51.1) vs 32 (21.5),P<0.001]、冠心病占比[例(%),11(23.4) vs 8 (5.4),P<0.001]、吸烟[是/否,23/24 vs 37/112,P=0.002]、病程[(14.9±15.1)个月vs (10.3±10.8)个月,P=0.022]均显著大于优良组。多因素逻辑回归显示吸烟史(OR=6.406,P<0.001)、高血压病史(OR=5.204,P=0.005)、BMI (OR=1.396,P<0.001)、年龄(OR=1.075,P=0.034)是多节段CSM经ELAP治疗后神经恢复不良的独立危险因素;而术前JOA评分(OR=0.465,P<0.01)及术后1个月C_(2~7)Cobb角(OR=0.841,P<0.05)则是术后神经功能恢复的保护因素。[结论] 年龄、BMI、高血压病史、吸烟史是多节段CSM经ELAP治疗后神经恢复不良的独立危险因素;术前JOA评分及术后1个月C_(2~7)Cobb角则是神经恢复的保护因素。[Objective]To explore the factors related to the clinical outcome of expansive open-door laminoplasty(ELAP)for treatmentof multilevel cervical spondylotic myelopathy.[Methods]From July 2020 to June 2023,196 patients were treated with ELAP for multilevelcervical spondylotic myelopathy.Univariate comparison and binary multifactor logistic regression analysis were used to analyze the factorsrelated to the recovery rate of neurological function.[Results]Of them,149 cases(76.0%)got excellent recovery of nerve function with recov-ery rate of≥50%(the good group),whereas the remaining 47 cases(24.0%)got recovery rate<50%(the poor group).In term of univariatecomparison,the poor group proved significantly greater than the good group regarding to age[(62.2±8.8)years vs(56.3±10.2)years,P<0.001],BMI[(27.0±2.9)kg/m^(2) vs(24.3±2.8)kg/m^(2),P<0.001],hypertension ratio[cases(%),24(51.1)vs 32(21.5),P<0.001],coronary heartdisease[cases(%),11(23.4)vs 8(5.4),P<0.001],smoking[y/n,(23/24)vs(37/112),P=0.002],and duration of disease[(14.9±15.1)monthsvs(10.3±10.8)months,P=0.022].As results of multivariate logistic regression,smoking(OR=6.406,P<0.001),hypertension(OR=5.204,P=0.005),BMI(OR=1.396,P<0.001),age(OR=1.075,P=0.034)were independent risk factors for poor neurological recovery after ELAP treat-ment in multi-segmental CSM.JOA score before surgery(OR=0.465,P<0.01)and C_(2~7) Cobb angle 1 month after surgery(OR=0.841,P<0.05)were protective factors for postoperative neurological recovery.[Conclusion]Age,BMI,history of hypertension,and smoking are inde-pendent risk factors for poor neurological recovery after ELAP treatment in multi-segmental CSM,while preoperative JOA score and C_(2~7)Cobb angle 1 month after surgery are protective factors for nerve recovery.

关 键 词：多节段脊髓型颈椎病 椎管扩大成形术 C_(2~7)Cobb角 神经功能恢复率 

分 类 号：R687[医药卫生—骨科学]