累及颈胸交界段的多节段颈椎前路融合术后疗效探讨

A research on outcomes of multilevel anterior cervical decompression fusion involving the cervicothoracic junction

目的探讨累及颈胸交界段的多节段颈椎前路融合手术融合范围与其疗效的关系。方法回顾2009年12月至2015年12月在复旦大学附属华山医院骨科接受多节段颈椎前路融合手术治疗的颈椎疾病患者75例,根据融合远端终止节段分为C7组(n=48)和T1组(n=27)。随访观察比较2组再次手术率、颈椎前凸角、颈椎矢状面轴向垂直距离及神经功能。所有计量资料采用SPSS19.0软件进行统计分析,组间资料及同组术前术后资料比较采用t检验,两组诊断、再次手术病例原因归总资料采用卡方检验。结果全部患者的再次手术率为9.3%,2组的再次手术率分别为C7组8.3%、T1组11.1%。2组术后颈椎前凸角(CL)、术后颈椎矢状面轴向垂直距离(SVA)、日本骨科协会(JOA)评分均较术前有明显改善(P<0.05),但同时期的组间比较,差异均无统计学意义(P>0.05)。2组末次随访的JOA评分改善率差异无统计学意义(P=0.52)。结论在应用累及颈胸交界段的多节段颈椎前路融合内固定术时,无论前路融合范围跨过C7/T1与否,对于手术预后、颈椎序列预后及神经功能恢复在中短期内并无影响。

Objective The aim of this study was to determine if there is a difference in the outcomes in patients who undergo a multilevel anterior cervical decompression fusions ending at C7 or T1. Methods Data of 75 cervical disease patients undergoing the multilevel anterior cervical decompression fusion from December2009 to December 2015 were retrospectively analyzed. Patients were separated into 2 groups on the basis of the caudal level of the fusion,C7 or T1. The revision rate,the C2-7 lordosis（ CL）,the C2-7 sagittal vertical axis（ SVA） and JOA scores were recorded and compared for patients with follow-up at least 1 year. Data were processed by SPSS19. 0 software. T-test was adopted in group measurement data. Omnibus Chi-square test was adopted in diagnose and revision rate data. Result The overall revision rate was 9. 3%（ Group C7： 8. 3%,Group T1： 11. 1%）. A significant improvement in CL,SVA and JOA scores of post-operation compared with pre-operation（ P〈0. 05）. However,there was no significant difference in comparison of CL,SVA and JOA scores between 2 groups（ P〉0. 05）. There was no significant difference in JOA scores recovery rates between 2groups（ P = 0. 52）. Conclusion No matter whether using a multilevel anterior cervical decompression fusions ending at C7 or T1,there is no difference in the postoperative outcomes,cervical alignment outcomes and neural functional recovery comparison.