C2-C7活动度预测脊髓型颈椎病症状严重程度的临床价值

Clinical value of C2-C7 activity in predicting the severity of cervical spondylotic myelopathy

目的探讨C2-C7活动度与脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者术前脊髓病变程度的相关性。方法选择2016年9月~2019年4月在本院就诊的114例CSM患者,对患者的生活质量、颈椎功能、脊髓神经功能和疼痛情况等临床指标分别进行SF-12量表评分、NDI评分、mJOA评分和VAS评分;测量患者的C2-C7矢状纵轴(C2-7SVA)、C7倾斜角(C7S)、C2-C7中立角(C2-7N)、C2-C7前屈角(C2-7F)和C2-C7后伸角(C2-7E)、C2-C7活动度(C2-7ROM)、颈椎曲率指数(Ishihara法),采用多元采用线性回归分析观察上述影像学指标与临床指标的相关性。结果NDI评分、SF-12生理评分、SF-12心理评分与C7N、C2-7E、C2-7F、C7S、Ishihara、C2-7ROM、C2-7SVA均无相关性(P<0.05),上肢VAS评分与C2-7N、C7S、Ishihara存在相关性(P<0.05),颈部VAS评分与C2-7N、Ishihara存在相关性(P<0.05),mJOA评分与C2-7F、C2-7ROM存在相关性(P<0.05)。以m JOA为变量,将年龄、性别、影像学指标等参数引入多元线性回归分析,结果显示,仅C2-7ROM是m JOA评分的相关因子(r=0.513,P<0.05)。结论C2-7ROM与CSM患者术前m JOA评分存在相关性。

Objective To investigate the correlation between C2-C7 activity and the degree of preoperative spinal cord lesion in patients with cervical spondylotic myelopathy(CSM).Methods From September 2016 to April 2019,114 CSM patients in our hospital were selected.SF-12 scale,NDI,m JOA and VAS were used to evaluate the quality of life,cervical function,spinal nerve function and pain.The sagittal longitudinal axis(C2-7 SVA),C7 tilt angle(C7 S),C2-C7 neutral angle(C2-7 N),C2-C7 forward flexion angle(C2-7 F),C2-C7 posterior extension angle(C2-7 E),C2-C7 activity(C2-7 ROM)and cervical curvature index(Ishihara)were measured.The correlation between the above imaging and clinical was observed by multiple linear regression analysis.Results There was no correlation between NDI,SF-12 physiology,SF-12 psychology and C7 N,C2-7 E,C2-7 F,C7 S,Ishihara,C2-7 ROM,C2-7 SVA(P<0.05).The VAS in upper limbs was correlated with C2-7 N,C7 S and Ishihara(P<0.05),VAS in neck was correlated with C2-7 N and Ishihara(P<0.05),and m JOA was correlated with C2-7 F and C2-7 ROM(P<0.05).Using m JOA as a variable,age,sex and image parameters were introduced into multivariate linear analysis.The results showed that only C2-7 ROM was the correlation factor of m JOA(r=0.513,P<0.05).Conclusion The C2-7 ROM is correlated with pre-operative m JOA in CSM patients.The next step is to explore the correlation between C2-7 ROM and post-operative efficacy of CSM patients by increasing follow-up.