颈椎单开门椎板成形术后脊髓后移程度的相关影响因素分析

Analysis of correlative factors of spinal cord posterior displacement after single door laminoplasty

目的 :观察慢性压迫性颈脊髓病患者行C3-C7单开门椎板成形术的开门角度、颈椎生理曲度、术前脊髓平均受压程度及术后脊髓平均漂移程度,探讨与术后脊髓平均漂移程度的可能机制及影响因素,为预测术后脊髓平均漂移程度提供相关客观依据。方法:回顾性分析2012年5月至2016年7月行颈椎单开门椎板成形术的多节段慢性压迫性颈脊髓病患者32例,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10例。在颈椎CT上测量开门角度,颈椎X线片上测量颈椎生理曲度,在MRI上测量术前脊髓平均受压程度、术后脊髓平均漂移程度,按术后脊髓平均漂移程度将患者分为A、B两组(A组≥2.5 mm,B组<2.5 mm)。A组男11例,女6例;年龄(56.58±9.80)岁,病程(23.52±7.86)个月。B组男6例,女9例;年龄(58.46±12.53)岁,病程(21.13±7.75)个月。将术后脊髓平均漂移程度与开门角度、颈椎生理曲度及术前脊髓平均受压程度进行相关性分析,对有相关性的参数进行多元线性分析。结果:A组开门角度(40.47±9.45)°,B组(27.84±5.67)°,A组开门角度大于B组(P<0.01),开门角度与术后脊髓平均漂移程度之间中度相关(r=0.794,P=0.000)。A组颈椎生理曲度(11.56±4.99)°,B组(6.64±3.28)°,A组颈椎生理曲度大于B组(P<0.01),颈椎生理曲度与术后脊髓平均漂移程度之间中度相关(r=0.632,P=0.000)。A组术前脊髓平均受压程度(27.70±2.92)%,B组(24.59±2.80)%,A组术前脊髓平均受压程度大于B组(P<0.01),术前脊髓平均受压程度与术后脊髓平均漂移程度之间中度相关(r=0.667,P=0.000)。颈椎生理曲度因变量被踢除(P>0.1),开门角度与术前脊髓平均受压程度的偏回归系数分别为0.113、0.059。结论:术后脊髓平均漂移程度是开门角度、术前脊髓平均受压程度及颈椎生理曲度多种因素的作用结果,其中术前脊髓平均受压程度影响最大,开门角度次之,颈椎生理曲度影响最小。术后脊髓平均漂移程度可以用0.059×开门角度+0.113×术前脊髓平均受压程度-2.266方程进行预测,为术前评估术后脊髓减压效果提供理论依据。

Objective:To observe the open angle(OA),cervical curvature angle(CA),preoperative spinal cord compression rate(PSCR),postoperative spinal cord shift(PSCS) in patients with chronic compressive cervical myelopathy undergoing C3-7 single open laminoplasty,and to explore the possible mechanism and influencing factors of postoperative average spinal cord drift,so as to provide objective basis for predicting PSCS. Methods:From May 2012 to July 2016,32 patients with multi-segmental chronic compressive cervical myelopathy who underwent single-door laminoplasty in our department were analyzed retrospectively,including 14 cases of cervical spondylotic myelopathy,8 cases of developmental cervical spinal stenosis with cervical myelopathy,and 10 cases of ossification of posterior longitudinal ligament. The OA of cervical spine was measured on CT,the CA was measured on X-ray,the PSCR and PSCS were measured on MRI. The patients were divided into two groups according to PSCS(group A≥2.5 mm,group B<2.5 mm). In the group A,there were 11 males and 6 females,with an average age of(56.58±9.80) years old,a mean course of the disease of(23.52±7.86) months;while in group B,there were 6 males and 9 females,with an average age of(58.46±12.53) years old,a mean course of disease of(21.13±7.75) months. The correlation analysis between PSCS and OA,CA and PSCR was performed,and multiple linear analysis of correlated parameters was carried out. Results:The OA in group A was(40.47±9.45) °,in group B was(27.84±5.67) °. The OA in group A was higher than that in group B(P<0.01),and OA was moderately correlated with PSCS(r=0.794,P=0.000). The CA was(11.56± 4.99) ° in group A and(6.64±3.28) ° in group B. The CA in group A was higher than that in group B(P<0.01),and CA was moderately correlated with PSCS(r=0.632,P=0.000). The PSCR was(27.70±2.92) % in group A,was(24.59±2.80) % in group B. The PSCR in group A was higher than that in group B(P<0.01),PSCR was moderately correlated with PSCS(r=0.667,P=0.000).The CA dependent variable was kicked out(P>0.1),and the partial regression coefficients of OA and PSCR were 0.113 and0.059 respectively. Conclusion:PSCS is the result of OA,CA and PSCR,among which PSCR has the most important influence,OA is the second,CA is the least. PSCS can be predicted by 0.059×OA+0.113×PSCR-2.266 equation,which provides a theoretical basis for preoperative evaluation of spinal cord decompression after surgery.