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

Influence of Cervical Expansive Open-door Laminoplasty on the Sagittal Balance of Cervical Spine

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.