颈椎前路术后融合节段曲度变化与轴性症状和神经功能的相关性研究

Curvature change of fused segment and axial syndrome/neurological function after anterior cervical fusion

目的观察颈椎前路术后融合节段的曲度变化,探讨其变化与患者颈部轴性症状和神经功能改善率的关系。方法对67例颈椎病前路手术患者随访3～16年,平均10.5年,在手术前和随访时对患者进行神经功能评分(JOA17分法),拍摄颈椎中立侧位X线片,测量融合节段曲度,将其分为无后凸、轻度后凸(后凸角≤5°)和明显后凸(后凸角>5°)组。对术后颈部轴性症状进行观察、分类及统计学分析。结果在随访期间颈部轴性症状发生率为38.81%,神经功能改善率为66.42%,融合节段后凸平均加重7.26°,后凸的发生率为53.73%,融合节段无或轻度后凸者与明显后凸者比较,其颈部轴性症状的发生率有显著性差异(P<0.05),神经功能改善率无显著性差异(P>0.1)。结论颈椎前路手术后多数患者融合节段的后凸程度加大,约半数患者出现后凸。融合节段后凸明显者出现颈部轴性症状的比率增加,但融合节段曲度改变和神经功能改善率无明显相关性。

Objective:Observing the curvature change after anterior cervical fusion and the relation to neck axial symptom and neurological outcome.Method:67 cases who have accepted anterior cervical fusion were followed up for 3～16 years,average 10.5 years.Judging the neurological outcome by using JOA grading system before and after operation.Curvature changing and kyphosis degree of the fused segment were evaluated on preoperative and follow-up x-rays.The sagittal alignment of the fused segment was categorized as no kyphosis, mild kyphosis(0 to -5 degree) or obvious kyphosis(<-5 degree).The neck axial symptoms after operation were observed at follow-up visit.Result:The incidence of neck axial symptom was 38.81%.Neurological function improved 66.42%.The average kyphosis degree increased 7.26°.The kyphosis rate of fused segment was 53.73%.The good result of neck symptom in obvious kyphosis was less than which in no or mild kyphosis(P<0.05).The neurological function had no significant difference in statistical analysis(P>0.1).Conclusion:Sagittal alignment of fused segment is worsened in majority of patients after anterior cervical fusion,half of them has kyphosis.Neck axial symptom increases in patients who had obvious kyphosis.There is no relation in fusion segment curvature and neurological function change.