颈椎前路融合节段相邻椎间盘压力与轴性症状关系初探

Primary Clinical Study of Pressure Change of Intervertebral Disc Adjacent to Fused Segments and Axial Symptoms after Anterior Cervical Fusion

目的分析在生理前凸获得有效重建的颈椎前路减压融合术中,融合节段相邻椎间盘压力变化与颈椎术后轴性症状发生的关系。方法行前路单椎体次全切除减压内固定手术治疗颈椎伤病42例,术中测量融合节段相邻椎间盘内压力,计算颈椎融合前后压力差。以D值法(C4椎体后下缘到齿状突后上缘与C7椎体后下缘连线的垂直距离,正值表示前凸)测量手术前后颈椎曲度变化,同时观察术后轴性症状的发生。分析颈椎曲度及相邻椎间盘压力变化与术后发生轴性症状的相关性。结果全部病例术后D值均为正值,与术前差异有显著性(P<0.05)。术后颈椎曲度变化与轴性症状发生无相关性(P>0.05),而相邻椎间盘压力变化与轴性症状发生有显著相关性(P<0.05)。术后发生轴性症状组(12例)相邻椎间盘压力差与无轴性症状组(30例)差异有显著性(P<0.05)。结论在生理前凸获得有效重建的颈椎前路减压融合术中,融合节段相邻椎间盘压力变化与术后轴性症状发生的关系密切。术中相邻椎间盘压力监测有助于准确掌握撑开程度,减少术后轴性症状的发生。

Objective To analyze the relationships between the pressure change of intervertebral disc adjacent to fused segments and axial symptoms in anterior cervical decompression and fusion （ACDF）, when lodorsis is maintained in all patients. Methods Forty-two patients with trauma and cervical spine diseases treated with anterior decompression, reconstruction and internal fixation by same doctors from January 2006 to January 2007 were included. The pressure of intervertebral disc next to fused segments was measured in the operation. The pressure change from preoperative to postoperative was calculated. The influences on restoration of cervical curvature were measured with D value （a straight line from the posterior circumference of the dens to the posterior- inferior border of C7 and another line from the posterior-inferior border of C4 perpendicular to the first line were drawn, its length was D value）, and the axial symptoms were observed at the same time. Then the relations of pressure change of intervertebral disc next to fused segments and axial symptoms were analyzed. Results D value of all patients was positive, and there was significant difference between preoperatively and postoperative D value （P〈0.05）. There were no relations between the change of curve and axial symptoms （P〉0.05）. But there were significant relations between the pressure change of intervertebral disc next to fused segments and axial symptoms （P〈0.05）. There were significant difference in pressure change of intervertebral disc next to fused segments between the group of axial symptoms （12 patients） and the group of no symptoms （30 patients） （P〈0.05）. Conclusion There are affinities of pressure change of intervertebral disc next to fused segments and axial symptoms in ACDF when lodorsis is maintained. Primary study indicates that pressure measure in the operation will help in control of the intensity of support, and axial symptoms can be decreased.