吸烟对颈椎人工间盘置换术后临床和影像学结果的影响

Effects of smoking on clinical and radiological outcomes after cervical disc replacement

目的:比较吸烟与非吸烟颈椎病患者颈椎人工间盘置换术(CDR)治疗后的临床和影像学结果。方法:分析2015年2月至2017年2月经CDR治疗的单节段或双节段颈椎病患者119例,最终纳入78例资料完整的患者。按照手术前6个月内是否吸烟,将所有患者分成吸烟组(27例)和非吸烟组(51例)。随访患者术前、术后的颈臂部疼痛视觉模拟量表(VAS)、颈椎活动障碍指数(NDI)、日本矫形协会量表(JOA)、Nurick量表、Bazaz的吞咽困难分级;术前及术后置换节段活动范围(ROM)、中立位颈椎前凸角(C 2~7 Cobb)和术后异位骨化(HO)。计数资料比较使用 χ2检验,计量资料组内数据比较采用配对样本 t检验,组间比较采用独立样本 t检验。 结果:共有78例患者获得随访,非吸烟组51例,吸烟组27例。与非吸烟组(50.4±11.1)岁比较,后者(42.3±9.6)岁更年轻( t=-21.737, P<0.05),且以男性为主(吸烟组:92.6%;非吸烟组:31.4%;χ2=9.625, P<0.05);两组患者在手术节段分布(单节段比例:70.4%比62.7%, χ2=0.761, P>0.05)、术中出血量[(22.7±10.5) ml比(24.3±11.2) ml, t=-0.716, P>0.05]、手术时间[(65.4±11.5) min比(63.9±12.1) min, t=0.832, P>0.05]、随访时间[(52.5±12.7)个月比(50.9±13.5)个月, t=0.661, P>0.05]等方面比较差异无统计学意义。两组在CDR治疗后的所有临床结果与术前比较均有相似的改善。吸烟组CDR术后置换节段ROM[术前:(7.3±4.2)°,术后:(7.8±4.6)°]保存良好( t=0.639, P>0.05);而非吸烟组在CDR术后置换节段的ROM[术前:(8.1±4.9)°,术后:(6.9±3.2)°]明显降低( t=18.564, P<0.05)。非吸烟组HO的发生趋势高于吸烟组,但差异无统计学意义(37.0%和33.3%, χ2=0.798, P>0.05)。而两组患者的其他的影像学评估均获得相似的结果。 结论:CDR在吸烟组可保持较好的ROM,可能是吸烟的颈椎病患者的合理选择。

Objective To compare the clinical and radiological outcomes in smoking patients after cervical disc replacement(CDR)with those of non-smoking patients.Methods A retrospective analysis was performed on 119 patients with single-segmental or two-segmental cervical spondylosis treated by CDR between February 2015 and February 2017.Finally,78 patients with complete data were included.All patients were divided into smoking(27 cases)and non-smoking(51 cases)groups based on whether they had smoked in the six months prior to surgery.The visual analogue scale(VAS),neck dysfunction index(NDI),Japanese orthopaedic association scale(JOA),Nurick scale,and Bazaz scores for dysphagia were compared and evaluated at different time points before and after operation.All patients were evaluated by these radiological parameters,such as range of motion(ROM)on the surgical segment,neutral cervical lordosis(C2-7 Cobb),and the presence of heterotopic ossification(HO).Chi-square test was used for comparison of counting data between the two groups,and paired t test was used for comparison of measurement data within the group.Independent sample t test was used for evaluation of intergroup data.Results A total of 78 patients were followed up for at least 3 years(mean follow-up period of 51.2 months).There were 51 cases in non-smoking group and 27 cases in smoking group.The age in the smoking group(42.3±9.6)was younger than in non-smoking group(50.4±11.1)(t=-21.737,P<0.05).The percentage of males in the smoking group(92.6%)was significantly higher than in the non-smoking group(31.4%;χ2=9.625,P<0.05).There were no statistically significant differences between the two groups in operative segment distribution(single-segmental ratio%)(70.4,62.7,χ2=0.761,P>0.05),intraoperative blood loss(ml)(22.7±10.5,24.3±11.2,t=-0.716,P>0.05),operative time(min)(65.4±11.5,63.9±12.1,t=0.832,P>0.05),and follow-up time(month)(52.5±12.7,50.9±13.5,t=0.661,P>0.05).Both groups showed similar improvements in all clinical outcomes before and after CDR treatment.In the smoking group,ROM on the surgical segment after CDR[preoperative:(7.3±4.2)°;postoperative:(7.8±4.6)°]was preserved well(t=0.639,P>0.05).However,in the non-smoking group,the ROM on the surgical segment was significantly reduced after CDR surgery[before surgery:(8.1±4.9)°;after surgery:(6.9±3.2)°,t=18.564,P<0.05].The occurrence trend of HO in the non-smoking group was higher than that in the smoking group,but the difference was not statistically significant(37.0%vs.33.3%,χ2=0.798,P>0.05).Other radiological assessments for patients in both groups yielded similar results.Conclusion CDR can maintain good ROM in smoking group,which may be a reasonable choice for smoking patients with cervical spondylosis.