术前颈椎过伸功能与颈椎后路单开门椎管扩大成形术后前凸角度丢失的关系

doi:10.3760/cma.j.cn101202-20191021-00316

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摘要目的探讨术前颈椎过伸功能与颈椎后路单开门椎管扩大成形术后前凸角度丢失的关系。方法回顾性分析首都医科大学大兴教学医院骨科2017年1月—2018年12月58例行颈椎后路单开门椎管扩大成形术患者临床资料,其中男45例、女13例,年龄49~85岁(平均64.8岁)。术前测量患者中立侧位X线片上的T₁倾斜角、矢状面垂直轴(SVA),以及中立侧位、过伸位X线片的C₂~C₇ Cobb角。随访12~24个月,术后再次测量中立侧位X线片上的C₂~C₇ Cobb角。术前颈椎过伸功能测量值为术前过伸位X线片C₂~C₇ Cobb角度减去术前中立侧位X线片C₂~C₇ Cobb角。前凸角度丢失量为术前中立侧位片C₂~C₇ Cobb角减去末次随访时中立侧位片C₂~C₇ Cobb角。依据58例患者术前颈椎过伸功能均值(8.7°)分为两组,≥8.7°为A组,＜8.7°为 B 组。比较两组患者术前及术后影像及临床资料,同时对58例患者的影像学资料与临床资料进行相关性分析。结果 A组25例患者年龄54~83岁,B组33例患者年龄49~85岁,两组患者术前年龄、性别、疾病种类差异均无统计学意义(P值均>0.05)。术前A组颈椎过伸功能(14.09°±4.75°)大于B组(4.62°±2.54°),A组T₁倾斜角(17.00°±3.40°)小于B组(29.68°±6.34°),颈椎前凸角度丢失[1.10(-0.85,4.00)]小于B组[8.60 (7.70,12.40)],差异均有统计学意义(P值均＜0.01)。颈椎过伸功能与前凸角度丢失之间呈负相关(r=-0.965, P＜0.01),T₁倾斜角与前凸角度丢失之间呈正相关(r=0.954, P＜0.01),颈椎过伸功能与T₁倾斜角呈负相关(r=-0.900, P＜0.01);SVA与T₁倾斜角、颈椎过伸功能、术后前凸角度丢失均无相关性(r=-0.065、0.216、-0.202, P＞0.05)。术后JOA评分改善率与过伸角度变化、SVA及T₁倾斜角均无相关性(r=0.201、-0.034、-0.213, P值均＞0.05)。A组术后JOA改善率为69%±23%,B 组术后JOA改善率为62%±23%,两组差异无统计学意义(t=1.147, P＞0.05)。术后Odom's分级评价A组优良率为88.0%(22/25),B组优良率为63.6%(21/33),差异有统计学意义(χ² =4.403, P<0.05)。结论对于后路单开门椎管扩大成形术患者,颈椎过伸功能与前凸角度丢失存在相关性,术前过伸功能越低,术后越易发生前凸角度丢失,可作为术前预判术后颈椎曲度变化的参数之一。

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	李悦
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关键词 ：颈椎病, 颈椎序列, 过伸功能, 后路手术, 前凸丢失

Abstract：Objective To explore the relationship between preoperative extension function (EF) and cervical curvature change after posterior cervical single open-door laminoplasty.Methods A retrospective review was performed on a group of fifty-eight cases that underwent cervical posterior single open-door laminoplasty from January 2017 to December 2018 at Daxing Teaching Hospital, Capital Medical University, including 45 males and 13 females. Aged 49-85 years(mean 64.8 years). Preoperative T₁ slope angle and sagittal vertical axis (SVA) were measured through neutral X-ray, and C₂-C₇ Cobb's angle was measured through neutral and extension radiographs. Postoperative measurement of the C₂-C₇ Cobb's angle was conducted at follow-up visits of 12-42 months. EF was defined as the extension C₂-C₇ Cobb's angle minus the preoperative neutral C₂-C₇ Cobb's angle. The loss of lordosis angle was C₂-C₇ Cobb's angle on preoperative neutral lateral radiograph minus C₂-C₇ Cobb's angle on neutral lateral radiograph at the last follow-up. Fifty-eight patients were divided into two groups in accordance with the mean of EF, namely, group A (≥8.7°) and group B (<8.7°). The preoperative and postoperative imaging and clinical data of the two groups were compared and analyzed.Results The age of 25 patients in group A ranged from 54 years to 83 years, and the age of 33 patients in group B ranged from 49 years to 85 years. No significant differences were found in preoperative age, gender, and disease type between the two groups (all P vales>0.05). EF in group A (14.09°±4.75°) was greater than that in group B (4.62°± 2.54°), with statistically significant difference (P<0.01). T₁ slope (17.00° ± 3.40°) in group A was lower than that in group B (29.68°±6.34°), with statistically significant difference (P<0.01). Loss of cervical lordosis in group A [1.10(-0.85, 4.00)] was less than that in group B [8.60 (7.70, 12.40)], with statistically significant difference (P<0.01). A linear and negative correlation (r=-0.965, P<0.01) was found between the group of patients with EF and loss of cervical lordosis. A linear correlation was observed between T₁ slope angle and loss of cervical lordosis (r=0.954, P<0.01). EF was significantly related to T₁ slope (r=-0.900, P<0.01). SVA had no significant correlation with T₁ slope, EF, and loss of cervical lordosis (r=-0.065, 0.216, -0.202, P>0.05). The recovery rate of the Japanese Orthopedic Association (JOA) score for patients in the two groups was not correlated with the radiologic parameters in this study (r=0.201, -0.034, -0.213, all P values>0.05). The postoperative JOA improvement rate of group A and group B were 69%±23% and 62%±23%, respectively. No significant difference was found between the two groups (t=1.147, P>0.05). For postoperative Odom's grading, the excellent and good rates of groups A and B were 88.0% (22/25) and 63.6% (21/33), respectively. A significant difference was found between them (χ²=4.403, P<0.05).Conclusions Preoperative EF is a measurement method closely related to T₁ slope and plays an important role in the evaluation of cervical sagittal balance. Patients with small EF have high probabilities to loss of cervical lordosis. EF can be used as a new factor in predicting the loss of cervical lordosis after laminoplasty.

Key words： Cervical spondylosis Cervical alignment Extension function Laminoplasty Loss of cervical lordosis

收稿日期: 2019-10-21

通讯作者: 孙文志,Email:sunwenzhi.ok@163.com

引用本文:

李悦, 孙文志, 甘立猛, 杨恺, 刘书茂. 术前颈椎过伸功能与颈椎后路单开门椎管扩大成形术后前凸角度丢失的关系[J]. 中华解剖与临床杂志, 2020, 25(3): 303-307.
Li Yue, Sun Wenzhi, Gan Limeng, Yang Kai, Liu Shumao. Relationship between preoperative extension function and cervical curvature change after posterior cervical single open-door laminoplasty. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 303-307.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20191021-00316 或 http://www.cjac.com.cn/CN/Y2020/V25/I3/303

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