脊髓型颈椎病患者颈椎管扩大成形术后行为习惯对脊髓功能恢复的影响  

The effect of behavioral habits on the recovery of spinal cord function for patients with cervical spondylotic myelopathy after expansive open-door laminoplasty

作　　者：田志康 李城 高升 白鲁岳 梁啸[2] 孟纯阳[2] Tian Zhikang;Li Cheng;Gao Sheng;Bai Luyue;Liang Xiao;Meng Chunyang(Clinical Medicine School of Jining Medical University,Jining 272067,China;Spinal Surgery Department of Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院临床医学院,济宁272067 [2]济宁医学院附属医院脊柱外科,济宁272029

出　　处：《中华行为医学与脑科学杂志》2024年第11期1034-1039,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金(82372477);山东省中医药科技项目(M-2022245);济宁市重点研发计划项目(2022YXNS001);济宁市重点研发计划项目(2022XYNS049)。

摘　　要：目的探讨行为习惯对脊髓型颈椎病患者颈椎管单开门扩大成形术(expansive open-door laminoplasty,ELAP)后脊髓功能恢复的影响。方法回顾性分析2019年2月至2022年10月因脊髓型颈椎病就诊于济宁医学院附属医院脊柱外科,接受ELAP治疗的183例随访信息完整的患者的临床资料。收集患者的一般临床资料。采用改良MacNab标准随访患者术后3个月,6个月及12个月的临床疗效。采用日本骨科协会评分(Japanese orthopaedic association,JOA)评价患者术前及术后12个月运动、感觉功能恢复情况,根据JOA评分计算患者脊髓功能恢复率,将患者分为疗效优良组(n=143,恢复率≥50%)及不良组(n=40,恢复率<50%)。使用SPSS 20.0软件通过卡方检验、秩和检验、采用t检验和Logistic回归分析对数据进行统计分析。结果疗效优良组和不良组在年龄(t=-3.252,P<0.01)、吸烟(χ^(2)=21.503,P<0.01)、体质量指数(body mass index,BMI)(t=-5.885,P<0.01)、高血压(χ^(2)=20.263,P<0.01)、冠心病(χ^(2)=13.272,P<0.01)、住院时间(t=-2.278,P=0.02)、伏案及视屏时间(t=-6.589,P<0.01)、康复锻炼频次(χ^(2)=10.927,P<0.01)的比较均差异有统计学意义。进一步多因素Logistic回归分析显示,吸烟(B=2.402,OR=11.046,95%CI=2.334~52.285,P<0.05)、BMI过高(B=0.341,OR=1.406,95%CI=1.076~1.837,P<0.05)、高血压病史(B=2.238,OR=9.370,95%CI=2.153~40.790,P<0.05)、伏案及视屏时间过长(B=0.961,OR=2.613,95%CI=1.54~4.435,P<0.05)、康复锻炼频次过少(B=-1.039,OR=0.354,95%CI=0.201~0.623,P<0.05)是影响脊髓型颈椎病患者ELAP术后脊髓功能恢复的危险因素。结论吸烟、高BMI、高血压病史、伏案及视屏时间过长、康复锻炼频次过少不利于脊髓型颈椎病患者ELAP术后的神经功能恢复。ObjectiveTo explore the effect of behavioral habits on the recovery of spinal cord function in patients with cervical spondylotic myelopathy after expansive open-door laminoplasty(ELAP).MethodsRetrospective analysis of clinical data of 183 patients with cervical spondylotic myelopathy who underwent ELAP at the Spinal Surgery Department of Jining Medical University Affiliated Hospital,from February 2019 to October 2022,with complete follow-up information.General clinical data of patients were collected.The patients were followed up at 3 months,6 months and 12 months after surgery with the modified standard MacNab.The JOA score was used to evaluate the recovery of motor and sensory functions in patients before and 12 months after surgery.The recovery rate of spinal cord function was calculated based on the JOA score,and patients were divided into two groups:the group with good therapeutic effect(n=143,recovery rate≥50%)and the group with poor therapeutic effect(n=40,recovery rate<50%).Data statistics were conducted using SPSS 20.0 software for chi-square test,rank sum test,t-test,and Logistic regression analysis.ResultsThere were significant differences in age(t=-3.252,P<0.01),smoking(χ^(2)=21.503,P<0.01),body mass index(BMI)(t=-5.885,P<0.01),hypertension(χ^(2)=20.263,P<0.01),coronary heart disease(χ^(2)=13.272,P<0.01),hospitalization time(t=-2.278,P=0.02),desk and screen time(t=-6.589,P<0.01),and frequency of rehabilitation exercise(χ^(2)=10.927,P<0.01)between the group with good therapeutic effect and the group with poor therapeutic effect.Further multivariate Logistic regression analysis showed that smoking(B=2.402,OR=11.046,95%CI=2.334-52.285,P<0.05),high BMI(B=0.341,OR=1.406,95%CI=1.076-1.837,P<0.05),hypertension(B=2.238,OR=9.370,95%CI=2.153-40.790,P<0.05),long desk and screen time(B=0.961,OR=2.613,95%CI=1.540-4.435,P<0.05)and low frequency of rehabilitation exercise(B=-1.039,OR=0.354,95%CI=0.201-0.623,P<0.05)were risk factors for spinal cord function recovery in patients with cervical spondylotic myelop

关 键 词：脊髓型颈椎病 行为 颈椎管单开门扩大成形术 术后康复 脊髓功能恢复 

分 类 号：R687.3[医药卫生—骨科学]