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

Effect of Posterior Cervical Expansive Open-door Laminoplasty on Cervical Sagittal Balance

目的探索颈椎后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化。方法收集2014年1月至2017年12月山西白求恩医院脊柱外科收治的108例接受颈椎后路单开门椎管扩大椎板成形术(C3~C7)患者的影像学及临床资料进行回顾性分析。比较术前及术后第24个月随访时C0~2 Cobb角、C2椎体矢状面垂直轴线至C7椎体后上缘的距离(C2~7 sagittal vertical axis,C2~7 SVA)、C2~7 Cobb角、T1-Slope 4项矢状面平衡影像学参数,对日本矫形外科协会颈椎功能评分(Japanese orthopaedic association,JOA)、颈椎功能障碍指数(neck disability index,NDI)、健康调查简表(the MOS item short from health survey,SF-36)、疼痛视觉模拟评分(visual analogue score,VAS)的变化以及轴性症状进行评定。结果患者术后24个月JOA及SF-36评分分别由术前的(11.16±2.28)分、(42.76±5.63)分增加至(14.08±2.17)分、(51.25±5.82)分,平均神经功能改善率为(46.5±3.8)%;NDI及VAS评分分别由术前的(15.61±5.43)分、(4.64±1.87)分降低至(11.36±7.93)分、(3.31±1.62)分,差异均有统计学意义(P<0.005)。C0~2Cobb角及C2~7 SVA分别由术前的(11.37±5.54)°、(21.09±5.86)mm增加至(15.36±4.51)°、(25.49±11.52)mm,C2~7 Cobb角由术前的(13.93±8.68)°减少至(10.65±8.72)°,差异均有统计学意义(P<0.005),T1-Slope则由术前的(26.84±5.10)°变化为随访时(26.31±4.8)°,差异无统计学意义(P=0.186)。随访时C0~2Cobb角的增加与C2~7 SVA的变化呈正相关(Pearson=0.420,P=0.015)。随访时的VAS评分高T1-Slope组为(3.13±1.60)分,低T1-Slope组为(2.45±1.31)分,差异有统计学意义(P=0.015);高T1-Slope组明显轴性症状的发生率为64.8%,低T1-Slope组为33.3%。结论颈椎后路单开门椎管扩大椎板成形术对颈椎矢状面平衡有一定影响,颈椎有前倾趋势,但通过上颈椎过度后伸的代偿,颈椎整体可以保持稳定。对于术前高T1-Slope的患者,术后会发生更严重的轴性症状。

Objective To explore the changes of cervical sagittal balance after posterior cervical expansive open-door laminoplasty procedure.Methods The radiological and clinical data were analyzed retrospectively for 108 patients undergoing posterior cervical expansive open-door laminoplasty(C3~C7)in Department of Orthopaedic Surgery,ShanXi Bethune Hospital,from January 2014 to December 2017.The C0~2 Cobb angle,C2~7 SVA,C2~7 Cobb angle,and T1-Slope were recorded before operation and at the 24thmonth follow-up.The preoperative and the 24thmonth follow-up Japanese Orthopaedic Association(JOA)score,neck disabilityindex(NDI),the MOS item short from health survey(SF-36),visual analog scale(VAS)were recorded respectively,the severity of axial symptoms was also recorded at the 24th month follow-up.Results The JOA score and SF-36 score increased to(14.08±2.17),(51.25±5.82)from pre-operative(11.16±2.28),(42.76±5.63).The NDI score and VAS score decreased from pre-operative(15.61±5.43),(4.64±1.87)to(11.36±7.93),(3.31±1.62)at the 24th month follow-up,respectively,the value changes were all statistically significant(P=0.001,P=0.001,P=0.001,P=0.022).The C0~2 Cobb angle,C2~7 SVA increase to(15.36±4.51)°,(25.49±11.52)mm formpre-operative(11.37±5.54)°,(21.09±5.86)mm,C2~7 Cobb angle decrease to(10.65±8.72)°frompre-operative(13.93±8.68)°,the value changes were all respectively statisticallysignificant(P=0.001,P=0.001,P=0.016).T1-slope changed from(26.84±5.10)°before operation to(26.31±4.8)°,the difference was not statistically significant(P=0.186).The change in C0~2 Cobb angle was positively related to the change in C2~7 SVA(Pearson=0.420,P=0.015).At the 24th month follow-up,the average VAS score of high T1 group was(3.13±1.60)and low T1 group was(2.45±1.31),the differences were statisticallysignificant between the 2 groups(P=0.015).The incidence of severe axial symptoms was 64.8%in the high T1-Slope group and 33.3%in the low T1-Slope group.Conclusion There was significant impact of posterior cervical expansive open-door laminoplasty procedure on cervical sagittal balance.The cervical vertebrae show a tendency of tilting forward,suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.And more severe axial symptoms often occurs in patients with high T1-Slope.