颈椎单开门椎板成形术术后轴性症状的影响因素分析

Analysis of influencing factors the postoperative axial symptoms of cervical single open door laminoplasty

目的:探讨慢性压迫性颈脊髓病患者行C_3-C_7单开门椎板成形术术后发生轴性症状(axial symptom,AS)的影响因素及其可能机制。方法:对2012年5月至2016年7月行C_3-C_7单开门椎板成形术的多节段慢性压迫性颈脊髓病32例患者的临床资料进行回顾性分析,其中脊髓型颈椎病14例,发育性颈椎管狭窄合并颈脊髓病8例,后纵韧带骨化症(OPLL)10例;男17例,女15例;年龄47～82岁,平均57.46岁;病程5～35个月,平均22.4个月。记录开门角度(opening angle,OA),颈椎生理曲度(cervical curvature angle,CA),术前脊髓受压率(preoperative spinal cord compression rate,PSCR)及术后脊髓漂移程度(postoperative spinal cord shift,PSCS)发生情况。术后2周根据AS评定标准判定患者是否出现AS情况,并将患者分为轴性症状组和非轴性症状组,将两组患者的一般资料及影像学参数进行差异性比较,将其中与术后AS发生具有相关性的参数再进行二元Logistic回归分析。结果:术后2周共有13例患者发生AS,轴性症状组与非轴性症状组患者的性别、年龄及病程一般资料比较差异无统计学意义(P>0.05),轴性症状组患者OA为(36.76±9.35)°,CA为(11.53±4.36)°,PSCR为(27.83±1.72)%,PSCS为(3.17±0.81)mm,非轴性症状组患者OA为(33.03±10.52)°,CA为(7.71±4.73)°,PSCR为(25.16±3.59)%,PSCS为(2.43±0.95)mm,两组患者的CA、PSCR及PSCS比较差异有统计学意义(P<0.05),两组的OA比较差异无统计学意义(P>0.05),OA、PSCR及PSCS 3个参数与AS的二元Logistic回归分析结果:OA、PSCR因变量被剔除(P>0.1),PSCR的偏回归系数为0.311,P=0.031。结论:CA、PSCR及PSCS是AS的相关影响因素,其中PSCS是AS发生的高危因素,脊髓后移过大引起的C_(4,5)颈神经牵拉、术后硬脊膜自身膨胀引起脊髓的牵张力变大及颈脊髓受压变形过大引起支配血管的植物神经损伤或坏死可能是AS的发病机制,但这只是理论推断,需要今后进一步完善实验去验证。

Objective：To explore the influencing factors and possible mechanisM1 of axial symptoms（AS） after C3-C7 single open-door laminoplasty in patients with chronic compression cervical myelopathy. Methods ：The clinical data of 32 patients with multi-segment chronic compression cervical cord disease treated by C3-C7 single open-door laminectomy from May 2012 to July 2016 were retrospectively analyzed. Including cervical spondylotic myelopathy of 14 cases, developmental cervical stenosis complicated with cervical myelopathy of 8 cases,ossification of posterior longitudinal ligament （OPLL） of 10 cases. There were 17 males and 15 females,aged from 47 to 82 years old with an average of 57.46 year,the course of disease was 5 to 35 months with an average of 22.4 months. The opening angle （OA）, cervical curvature angle （CA）, preoperative spinal cord compression rate （PSCR） and postoperative spinal cord shift （PSCS） were recorded. After 2 weeks of surgery, determining whether occurred an AS condition according to the AS assessment criteria, the patients were divided into a axial symptom group and a non-axial symptom group, the general data and imaging parameters of the two groups were compared and the factors that may be postoperative AS were analyzed by binary Logistic regression analysis. Results：At 2 weeks after operation, 13 patients occurred AS. There was no significant difference in gender,age and course of disease between axial symptom group and a non-axial symptom group （P〉0.05）. In axial symptom group, OA was（36.76±9.35）°, CA was（11.53±4.36）°,PSCR was（27.83±1.72）%,PSCS was （3.17±0.81） mm,while in non-axial symptom group,above items were （33.03±10.52）°, （7.71±4.73）°, （25.16±3.59） %, （2.43±0.95） mm, respectively, there was significant difference in CA, PSCR, PSCS between two groups （P〈0.05）, and there was no significant difference in OA between two groups（P〉0.05）. The results of the binalT Logistic regression analysis of 3 parameters （OA, PSCR, PSCS） and AS showed OA and PSCR were eliminated in dependent variables, and the partial regression coefficient of PSCR was 0.311, and P=0.031. Conclusion： CA, PSCR, and PSCS are related influencing factors of AS, and PSCS is a high risk factor for AS. C4,5 nerve traction caused by posterior spinal movement, postoperative dural self-expansion causes greater traction of the spinal cord,excessive deformation of the cervical spinal cord causes autonomic nerve damage or necrosis that dominates blood vessels may be the pathogenesis of AS,but this is only a theoretical inference,and further improved experiment is necessary to verify it in the future.