颈椎椎管扩大成形术后生理曲度恶化的相关因素分析

Analysis of relative factors influencing cervical lordosis after posterior cervical laminoplasty

目的探讨影响颈椎椎管扩大成形术术后颈椎生理曲度的相关因素。方法对256例颈椎椎管扩大成形术患者的性别、术前颈椎的稳定性、术中是否破坏C2后柱结构完整性、术后功能锻炼及术后颈椎生理曲度行单因素分析及Logistic回归分析。结果术前Cobb角为(5.12±3.44)°,术后为(-4.96±4.49)°(t=23.34,P<0.01)。性别与生理曲度无相关性(P>0.05)。术前颈椎不稳定倾向与颈椎生理曲度变化的相关系数为B=1.002,P=0.02,有相关性;术中破坏C2后柱结构与颈椎生理曲度变化的相关系数为B=1.023,P=0.03,有相关性;术后是否进行正规颈椎功能锻炼与颈椎生理曲度变化的相关系数为B=1.034,P=0.02,有相关性。结论术前有颈椎不稳或不稳倾向者术后易出现颈椎生理曲度的恶化;术中C2后柱结构的破坏及术后非正规的项背肌功能锻炼与颈椎后突畸形的发生有关。

Aim： To evaluate the relative factors influencing the cervical lordosis after posterior cervical laminoplasty. Methods：A retrospective study was used to analyse the 256 patients who received posterior cervical laminoplasty. Gender, preoperative stability, intraoperative C2 post element injury, postoperative exercises, and the cervical lordosis condition 2 years after operation were studied. Results： The preoperative Cobb was （5. 12± 3.44）°, the postoperative Cobb was （ - 4.96 ± 4.49） ° （ t = 23.34, P 〈 0.01 ）. There were no correlations between gender and the lordosis deformity （ P 〉 0.05 ）. The preoperative instability was correlated with cervical lordosis （B= 1. 002 ,P =0.02）. The C2 posterior element injury was correlated with cervical lordosis （B = 1. 023, P = 0.03 ）. The postoperative exercise was correlated with cervical lordosis （B = 1. 034,P = 0.02）. Conclusion： The patients with preoperative cervical instability are prone to have cervical lordosis deterioration. The C2 posterior elements injury and abnormal cervical muscular exercise have correlation with cervical kyphosis.