颈椎矢状位参数与多节段脊髓型颈椎病一期前后路联合术疗效的相关性

Correlation Between Cervical Sagittal Parameters and Clinical Efficacy After OneStage Anterior-Posterior Approach Surgery on MultilevelCervical Spondylotic Myelopathy

目的探讨颈椎矢状位参数与多节段脊髓型颈椎病(MCSM)一期前后路联合术疗效的相关性。方法回顾性分析2014年3月至2016年12月于郑州大学第一附属医院骨科接受一期前后路联合术治疗的41例MCSM患者的临床及影像学资料,收集患者性别、年龄、病程、手术时间、术中出血量以及术前和末次随访时日本骨科协会(JOA)评分、C 2~7 Cobb角、颈椎曲度(Harrison法)、T 1倾斜角(T 1S)、矢状面轴向距离(SVA)、责任节段前柱高度等相关资料。统计分析各项临床指标和矢状位参数之间的差异及相关性,并运用多因素二元logistic回归分析预后的影响因素。进一步绘制受试者工作特征曲线(ROC),明确预后相关因素的临界值。结果41例患者末次随访时JOA评分及各矢状位参数(C 2~7 Cobb角、责任节段前柱高度、颈椎曲度、T 1S、SVA)均较术前增加(P<0.001)。Pearson相关分析显示,C 2~7 Cobb角改变值与颈椎曲度改变值呈正相关(r=0.518,P<0.05),与SVA改变值呈负相关(r=-0.366,P<0.05);颈椎曲度改变值与SVA改变值呈负相关(r=-0.375,P<0.05);T 1S改变值与责任节段前柱高度改变值呈正相关(r=0.318,P<0.05),与SVA改变值呈正相关(r=0.463,P<0.05)。多因素二元logistic回归分析显示,C 2~7 Cobb角改变值是MCSM预后的影响因素(P<0.05)。ROC曲线显示,C 2~7 Cobb角改变值诊断临界值为7.98°。结论一期前后路联合手术治疗MCSM具有显著的效果,术后各矢状位参数出现显著变化,且C 2~7 Cobb角改变值为患者预后的主要影响因素,有利于评估近期预后。

Objective To explore the relationship between cervical sagittal parameters and clinical efficacy after one stage anterior-posterior approach surgery on multilevel cervical spondylotic myelopathy(MCSM).Methods The clinical and imaging data of 41 cases of MCSM treated with one stage anterior-posterior approach surgery in the Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University from March 2014 to December 2016 were retrospectively analyzed.The data of gender,age,course of disease,operation time,intraoperative blood loss,Japanese orthopaedic association(JOA)score,C 2~7 Cobb angle,cervical curvature(Harrison method),T 1 slope(T 1S),sagittal vertical axis(SVA)and anterior column height of responsible segment before operation and at the last follow-up were collected.The differences and correlations between various clinical indicators and cervical sagittal parameters were statistically analyzed.Multivariate binary logistic regression analysis was used to analyze the influencing factors of prognosis.The receiver operating characteristic curve(ROC)was further drawn to determine the critical value of prognosis related factors.Results The JOA score and cervical sagittal parameters(C 2~7 Cobb angle,anterior column height of responsible segment,cervical curvature,T 1S and SVA)of 41 patients at the last follow-up were higher than those before operation(P<0.001).Pearson correlation analysis showed that the change value of C 2~7 Cobb angle was positively correlated with the change value of cervical curvature(r=0.518,P<0.05),and the change value of C 2~7 Cobb angle was negatively correlated with the change value of SVA(r=-0.366,P<0.05).The change value of cervical curvature was negatively correlated with the change value of SVA(r=-0.375,P<0.05).The change value of T 1S was positively correlated with the change value of anterior column height of responsible segment(r=0.318,P<0.05),and the change value of T 1S was positively correlated with the change value of SVA(r=0.463,P<0.05).Multivariate binary logistic regression analysis showed that the change value of C 2~7 Cobb angle was the main factor affecting the prognosis of MCSM(P<0.05).ROC showed that the diagnostic critical value of the change value of C 2~7 Cobb angle was 7.98°.Conclusion One stage anterior-posterior approach surgery is effective in the treatment of MCSM,and cervical sagittal parameters have changed significantly after operation.The change value of C 2~7 Cobb angle is the main factor influencing the prognosis,which is helpful to predict the short-term prognosis.