人工颈椎间盘置换术后远期随访发生异位骨化及骨吸收的危险因素分析  

Risk Factors for Heterotopic Ossification and Vertebral Anterior Bone Loss Following Cervical Disc Replacement Surgery:A Long-term Follow-up Study

作　　者：李盼 苏康康 于得臣 雷润博 曹雄飞 甘璐 李沫 罗卓荆 Li Pan;Su Kangkang;Yu Dechen;Lei Runbo;Cao Xiongfei;Gan Lu;Li Mo;Luo Zhuojing(Department of Orthopedics,Xijing Hospital,Air Force Military Medical University,Xian 710032,China)

机构地区：[1]空军军医大学附属西京医院骨科,西安710032

出　　处：《骨科》2024年第6期481-487,共7页ORTHOPAEDICS

基　　金：国家自然科学基金(82401852);陕西省重点研发计划项目(2024SF-GJHX-25)。

摘　　要：目的探讨人工颈椎间盘置换术(cervical disc replacement,CDR)后远期发生异位骨化(HO)及椎体前缘骨吸收(ABL)的危险因素。方法本研究回顾性分析了2009年1月至2012年12月期间在我院接受CDR手术的86例病人。收集病人性别、年龄、身体质量指数(BMI)等一般资料;术前、术后日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)、健康状况调查表-36躯体健康评分(SF-36PCS);C2~C7活动度、手术节段活动度、HO程度、ABL情况等。末次随访时根据McAfee分级法将病人分为低等级HO组(无HO或McAfee Ⅰ~Ⅱ级)和高等级HO组(McAfee Ⅲ~Ⅳ级)。先后通过多变量回归分析、逻辑回归分析,评估术后发生高等级HO及ABL的相关危险因素。结果末次随访时,36例纳入低等级HO组,50例纳入高等级HO组,两组病人术后临床疗效相关评分相较于术前均有显著改善(P<0.05)。术后发生HO的危险因素包括:年龄[OR=1.030,95%CI(1.010,1.052),P=0.032]、男性[OR=1.842,95%CI(1.113,3.052),P=0.019]、吸烟史[OR=2.214,95%CI(1.282,3.833),P=0.005]、高BMI[OR=1.154,95%CI(1.073,1.240),P=0.001]、术前钩椎关节退变[OR=2.180,95%CI(1.282,3.634),P=0.004]、手术节段活动度丧失[OR=1.262,95%CI(1.082,1.454),P=0.003]。发生ABL的风险因素包括:术后早期过度活动[OR=2.120,95%CI(1.241,3.620),P=0.003]、骨质疏松[OR=1.322,95%CI(1.101,1.582),P=0.027]、长期使用类固醇药物[OR=2.750,95%CI(1.542,4.920),P=0.016]、术前钩椎关节退变[OR=1.682,95%CI(1.182,2.262),P=0.044]。结论CDR术后HO和ABL的发生与多种因素相关,针对这些高危人群应采取个性化的预防和治疗策略,以提高术后疗效,减少并发症的发生。Objective To investigate the risk factors associated with the long-term occurrence of heterotopic ossification(HO)and vertebral anterior bone loss(ABL)following cervical disc replacement(CDR).Methods A retrospective analysis was conducted on 86 patients who underwent CDR between January 2009 and December 2012 in our hospital.The general information such as gender,age,body mass index(BMI),the Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS),Neck Disability Index(NDI),Short Form 36 Physical Component Summary(SF-36PCS)before and after surgery,overall C2-C7 range of motion,segmental range of motion,HO severity and ABL were collected.Patients were classified into low-grade HO group(including no HO and McAfee grades Ⅰ-Ⅱ)and high-grade HO group(including McAfee grades Ⅲ-Ⅳ)at the last follow-up based on the McAfee classification.The associated risk factors for the occurrence of high-grade HO and ABL postoperatively were analyzed by multivariate regression analysis and Logistic regression analysis.Results At the last follow-up,36 cases were included in the low-grade HO group and 50 cases in the high-grade HO group.Both groups showed significant improvement in clinical outcome scores compared to preoperative status(P<0.05).Risk factors for postoperative HO included age[OR=1.030,95%CI(1.010,1.052),P=0.032],male[OR=1.842,95%CI(1.113,3.052),P=0.019],smoking history[OR=2.214,95%CI(1.282,3.833),P=0.005],high BMI[OR=1.154,95%CI(1.073,1.240),P=0.001],preoperative facet joint degeneration[OR=2.180,95%CI(1.282,3.634),P=0.004],loss of segmental motion[OR=1.262,95%CI(1.082,1.454),P=0.003].Risk factors for ABL included early postoperative excessive activity[OR=2.120,95%CI(1.241,3.620),P=0.003],osteoporosis[OR=1.322,95%CI(1.101,1.582),P=0.027],long-term steroid use[OR=2.750,95%CI(1.542,4.920),P=0.016],and preoperative facet joint degeneration[OR=1.682,95%CI(1.182,2.262),P=0.044].Conclusion The occurrence of HO and ABL following CDR is associated with multiple factors.Personalized preventive and treatment st

关 键 词：人工颈椎间盘置换术 异位骨化 前缘骨吸收 危险因素 

分 类 号：R687.3[医药卫生—骨科学]