颈椎前路融合术后颈部运动功能的评价

Evaluation of neck moving ability after anterior cervical fusion

目的观察颈椎前路融合术后相邻节段的退变情况和颈部症状的关系,以及颈椎各节段和整体活动度在手术前后的变化。方法对66例颈椎前路融合术后的患者随访1-16年,平均10.5年,观察融合相邻节段在过伸、过屈侧位X线片上的活动度和成角、滑移程度,及其和颈部症状之间的关系。将其中59例患者的手术前后整体颈椎和未融合节段的活动度进行对比,寻找其变化规律。结果在随访期内观察到的相邻节段不稳定发生率为72.7％,有明显颈部症状者占40.9％。融合相邻节段不稳定的患者中有明显颈部症状者占48.0％,相邻节段稳定者中出现明显颈部症状者占18.8％,其差异有显著性意义(P<0.05),轻度不稳定和显著不稳定者发生明显颈部症状的差异无显著性意义(P>0.1)。患者手术后整体颈椎的活动度明显变小(P<0.001),相邻节段活动度显著增大(P<0.01),非相邻节段活动度无明显变化(P>0.05)。结论颈椎前路融合术后多数患者将出现相邻节段不稳定,但是多数患者颈部无明显症状,相邻节段不稳定是颈部症状发生的原因之一。

Objective To observe the relationship of adjacent segment degeneration and neck symptom after anterior cervical fusion. Methods Making follow-up to 66 cases who had accepted anterior cervical fusion for 1-16 years, average 10. 5 years. Observe the mobilization and gliding degree of adjacent segment in flexion-extension X-ray film, neck symptom, and the relationship of them. In 59 of these patients, the mobilization of entire cervical spine and non-fusion segment was observed before/after operation. Results The incidence of adjacent segment instability in follow-up term was 72. 7% , and 40. 9% of all patients had significant neck symptom. The rate of significant neck symptom in patients who had instability was 48% , whereas which in patients without instability was 18. 8% , and the difference was statistically significant ( P < 0. 05 ) . The difference of mild instability and severe instability was not statistically significant ( P > 0. 1 ) . The mobilization of entire cervical spine decreased obviously ( P < 0. 001). The mobilization of adjacent segment increased obviously ( P < 0. 01), and which of non-adjacent segment had no change ( P > 0. 05 ) . Conclusion Majority of patients who have accepted anterior cervical fusion possessed instability of adjacent segment, but many of them have no symptoms. Adjacent segment instability is one of the reasons that induce neck symptoms.