ACDF联合前路颈椎桥型锁定融合器固定单节段椎体治疗脊髓型颈椎病术后椎间隙塌陷的多因素分析

Multi-factor analysis of ACDF combined with ROI-C for treatment of cervical spondylotic myelopathy

目的探讨颈前路椎间盘切除植骨融合术(ACDF)联合前路颈椎桥型锁定融合器固定单节段椎体治疗脊髓型颈椎病(CSM)术后椎间隙塌陷的危险因素。方法回顾性分析2015年2月至2017年2月采用ACDF联合前路颈椎桥型锁定融合器单节段固定椎体术治疗的62例CSM患者的临床资料并进行随访,根据患者随访期间发生椎间隙塌陷(CS)的情况绘制患者的生存曲线。根据患者在随访期内是否发生CS分为塌陷组和未塌陷组。对两组间年龄、性别、吸烟史、骨密度、手术节段、术前颈椎生理曲度(CA)、前后凸角(SA)、前高度(ADH)、后高度(PDH)等因素进行COX单因素分析。对分析结果有差异的因素进一步做COX多因素回归分析。最后绘制术前CA值预测患者术后CS的ROC曲线并分析术前CA值对于术后CS发生的最佳预测点。结果完成随访的有62例患者,有27例发生CS(塌陷组),35例至终未发生CS(非塌陷组)。患者的术前SA、术前CA、术前ADH对患者术后发生CS有影响,差异有统计学意义(P <0. 05),患者的性别、年龄、吸烟史、手术节段、术前骨密度及术前PDH对患者术后发生CS无影响,差异无统计学意义(P> 0. 05)。将术前SA值、CA值、ADH进一步行COX多因素分析,术前SA值以及ADH对术后CS的发生无显著影响(P> 0. 05),患者术前CA值是术后CS的危险因素,差异有统计学意义(RR=0. 461,P=0. 018)。术前CA评估术后CS发生的AUC为0. 753,术前CA的最佳预测值为2. 960,其敏感度为68. 6%,特异度为18. 5%。结论术前CA值是单节段ACDF联合颈椎桥型锁定融合器单节段椎体治疗CSM术后发生CS的独立危险因素,且其值取2. 960时,对术后发生CS的预测作用最佳。

Objective To explore the risk factors of anterior cervical discectomy and fusion(ACDF)combined with ROI-C fixed single-segment vertebral body for treatment of cervical spondylotic myelopathy(CSM).Methods The clinic data of sixty-two patients who underwent single-level ACDF with ROI-C for CSM between February 2015 and February 2017 was analyzed and followed up.According to occur CS or not,they were divided into CS group and un-CS group.Age,gender,smoking history,bone mineral density,the operation section,preoperative CA,SA,ADH,PDH were analyzed by cox single regression analysis.And then,the factor which has been proved to be statistically significant were adopted in cox multivariate regression analysis to estimate the independent risk factor of CS.Finally,ROC curve was used to determine the best preoperative CA reference values to improve its predictive value of the postoperative CS.Results there were 62 cases who completed follow-up,among them,there were 27 cases occurred CS and 35 cases not.These factors such as age,gender,history of smoking,surgery section,preoperative BMD and preoperative PDH showed no significant impact on postoperative CS by cox single regression analysis,difference was not statistically significant(P>0.05).The preoperative CA,SA,ADH were the impact factors of postoperative CS,difference between the two groups was statistically significant(P<0.05).While,preoperative CA、SA、ADH were analyzed by cox multivariate regression analysis,the result showed there was no significant relationship between the preoperative ADH and SA with postoperative CS(P>0.05).Preoperative CAwas the independent risk factor of CS(RR=0.461,P=0.018).And,the cutoff-value of postoperative CS prediction was 2.960 with sensitivity 68.6%and specificity 18.5%.Conclusion The value of CA is an independent risk factor of CS after underwent single-level ACDF with ROI-C and the cutoff-value is 2.960.