摘要
目的:探讨颈椎后路单开门椎管扩大椎板成形术对颈椎矢状面平衡的影响。方法:收集2012年1月至2015年1月在我院接受治疗的85例脊髓型脊椎病患者,均行颈椎后路单开门椎管扩大椎板成形术。观察比较手术前后患者的日本骨科协会(JOA)评分、生活质量评分(SF-36)、颈椎功能障碍指数(NDI)以及疼痛视觉模拟评分(VAS)情况,手术前及末次随访时患者的X线侧位片C2椎体与颅底连线的夹角(Cobb)、C2椎体矢状面的垂直轴线与C7椎体上缘的长度(SVA)、T1椎体上缘线和水平线的夹角(T1-Slope)以及三者间的相关性。结果:患者术后JOA评分较术前显著升高,升高量为(2.6±0.2)分(P<0.05),神经功能改善率为50.1%,术后SF-36、NDI及VAS评分均有显著改善(P<0.05)。相较于手术前,患者末次随访时的C2-C7 SVA、C0-2 Cobb夹角以及T1-Slope均有显著升高,C2-C7 SVA升高量与C0-2 Cobb夹角、T1-Slope的升高量呈显著正相关性(r=0.475,P<0.001;r=0.327,P=0.003)。手术前,患者的JOA评分与C2-C7 SVA呈一定负相关(r=-0.229,P=0.032),手术后两者间无明显相关性(P>0.05)。结论:颈椎后路单开门椎管扩大椎板成形术显著影响颈椎矢状面平衡,以颈椎前倾为主要表现,而引起患者颈椎肌肉持续性收缩、上颈椎过度前凸。
Objective: To investigate the influence of cervical expansive open-door laminoplasty on sagittal balance of cervical spine. Methods: Eighty-five patients with cervical spondylotic myelopathy admitted into our hospital ~om January 2012 to January 2015 were treated with cervical expansive open-door laminoplasty. The JOA score, SF-36, NDI, and VAS before and after operations were observed and compared. And the cervical sagittal parameters including C0-2 Cobb angle, C2-C7 SVA, and T1-Slope based on lateral view radiographs before operation and at the last follow-up were also compared, and correlation between those three parameters was analyzed. Results: After operation, the JOA score of all patients were showed significant increase (P 〈 0.05), and the increment was 2.6± 0.2 with 50.1% of improvement rate. The score of SF-36, NDI, and VAS had markedly improvement (P 〈0.05). Compared to before operation, C0-2 Cobb angle, C2-C7 SVA, and T1-Slope at last follow-up indicated remarkable increase (P 〈0.05). Additionally, at last follow-up, the variation of C0-2 Cobb angle and T1-Slope were positively correlated with those ofC2-C7 SVA, respectively (r=0.475, P 〈0.001; r=0.327, P=0.003). And the JOA score showed a negative correlation with C2-C7 SVA (r=-0.229, P=0.032) before operation, while there was no correlation between them after operation (P〉0.05). Conclusion: Cervical expansive open-door laminoplasty had an obvious influence on sagittal balance of cervical spine with main symptoms of forward tilting of cervical vertebra, and resulting in excessive high-strength contraction of posterior muscle, and lordosis in upper cervical spine.
作者
刘伟
倪建龙
王亚康
赵奋伟
张晶
卫宝宁
LIU Wei NI Jian-long WANG Ya-kang ZHAO Fen-wei ZHANG Jing WEI Bao-ning(Department of Orthopedics, the First Hospital of Yulin, Yulin, Shaanxi 719000, China Department of Orthopedics, the Second Attiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China Department of Ozlhopedics, the AfSliated Honghui Hospital of Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China)
出处
《现代生物医学进展》
CAS
2017年第10期1886-1888,1989,共4页
Progress in Modern Biomedicine
关键词
颈椎病
颈椎
矢状面平衡
Cervical spondylosis
Cervical vertebrae
Sagittal balance