两种颈后路术式对颈椎曲度及椎间高度的中期影响

Clinical mid- term effect of surgical posterior decompression methods on cervical curvature and intervertebral height

[目的]探讨颈后路单开门椎管扩大成形术及颈后路全椎板减压侧块螺钉内固定术治疗多节段脊髓型颈椎病的中期疗效。[方法]2005年7月～2010年12月期间132例脊髓型颈椎病患者按照手术方式分为A、B两组,A组54例采用颈后路单开门椎管扩大椎板成形术治疗;B组78例采用颈后路全椎板减压侧块螺钉内固定术。随访观察并对两组患者的颈椎曲度、颈椎前凸角、颈椎活动度及椎间高度等情况进行评估。[结果]两组术后脊髓功能与术前相比均得到明显改善(P<0.05),术后2年随访时,JOA改善率方面组间比较无统计学意义(P>0.05)。术后同期随访时在神经根麻痹及轴性症状发生率方面A组明显高于B组,组间比较差异有统计学意义(P<0.05)。A组术前颈椎前凸角度、颈椎曲度指数及椎间高度与术后3 d比较,差异无统计学意义(P>0.05);B组同期比较,差异有统计学意义(P<0.05)。A组术前颈椎活动度与术后3 d比较,差异有统计学意义(P<0.05);B组同期比较,差异有统计学意义(P<0.05)。A组术后3 d颈椎前凸角度、颈椎曲度指数及椎间高度与术后2年A组比较,差异有统计学意义(P<0.05);同期B组比较,差异无统计学意义(P>0.05)。A组术后3 d颈椎活动度与术后2年比较,差异无统计学意义(P>0.05);B组同期比较,差异无统计学意义(P>0.05)。[结论]两种颈后路手术方式治疗多节段脊髓型颈椎病均能有效改善脊髓功能。颈后路单开门椎管扩大椎板成形术能有效的保留颈椎活动度;颈后路全椎板减压侧块螺钉内固定术有效改善并维持了颈椎生理曲度以及椎间高度,防止颈椎前凸角的丢失,神经根管和椎间孔的减压大大降低了术后轴性症状以及神经根麻痹的发生率。

[ Objective] The purpose of this study was to measure the tibiofemoral torsion deformity in varus knee osteoar- thritic of Chinese patients and to evaluate the accurate rotational reference for tibia prosthesis placement. [ Methods] We evalu- ated computed tomographic （CT） scans and conventional radiographs of 65 patients （5 men, 60 women） with varus osteoarthritis of the knee. Using RadiAnt software, the hip -knee -ankle angle （HKA） and the tibiofemoral angle （TFA） were measured from radiographs. RadiAnt software was also used on CT slices to measure the tibiofemoral joint torsion angle （TFTA）, which included the Akagi＇ s line, 1/3 medial tibial tubercle （1/3 TT angle）, and patellar tendon ratio （PT ratio）, intersected by a vertical line corresponding to the projected surgical transepicondylar axis. The relationship of the TFTA variables, including the Akagi＇ s angle, 1/3 TF angle, and PT ratio, to the HKA were analyzed. [Results] In the 65 cases, the average HKA and TFA were （ 170. 76 ± 4. 55） ° and （2.44 ± 4. 17） °, respectively. The PCA, Akagi＇ s angle, and 1/3 TT angle, measured with CT, were （1.29±1.95）° （range, -3.10° to 5.20°）, （ -2.91±4.03）° （range, -13.00° to 5.40°）, and （6.24± 4. 23）° （ range, - 5.10° to 16. 70°） , respectively. The Akagi＇ s axis was internal rotated and 1/3 TY line external rotated cor- respondingto the projected surgical transepicondylar axis. The PT ratio averaged （25.11 ± 12. 27 ）%, with a range from 0. 00% to 60. 92%. The Akagi＇ s angle, 1/3 TT angle, and PT ratio had no linear correlations with the HKA angle （ P 〉 0. 05）. [ Conclusion] The average tibiofemoral torsion angle was 2. 91° in varus osteoarthritic knees of Chinese patients. TheAkagi＇ s axis and 1/3 TT methods to determine the tibial external rotation are not suitable for Chinese patients. However, the axis from the 1/4 medial patellar tendon to the PCL center （ medial pa-tellar ligament average of 6. 75mm） is an accurate and reliable method for correct tibia prosthesis rotational placement.