颈椎前路Hybrid术在治疗颈椎退行性疾病中对活动度和曲度的影响

Efficacy of Hybrid anterior cervical spine surgery on range of motion and curvature in the treatment of cervical degenerative diseases

目的:观察颈椎前路Hybrid术后6个月影像学上颈椎曲度和活动度的变化。方法:回顾性分析2017年1月至2018年7月接受颈椎前路Hybrid术的颈椎退行性疾病患者,符合纳入标准并获得术前和术后6个月影像学资料者29例。男11例,女18例,年龄34~76(55.86±10.69)岁,手术时间2~4(3.03±0.51)h。采用Cobb角法测量术前和术后6个月颈椎X线侧位片上C_(2)-C_(7)、置换、融合及上位相邻节段曲度和活动度的变化。结果:术后6个月C_(2)-C_(7)曲度和活动度与术前比较,差异无统计学意义(P>0.05);置换节段曲度和活动度较术前增加(P<0.05);融合节段曲度较术前增加(P<0.05),融合节段活动度与术前比较,差异无统计学意义(P>0.05);上位相邻节段的曲度和活动度与术前比较,差异无统计学意义(P>0.05)。横向比较:术前和术后6个月时置换和融合节段曲度比较,差异均无统计学意义(P>0.05);术后6个月置换节段活动度高于融合节段活动度(P<0.05)。结论:颈椎前路Hybrid术重建了颈椎整体和责任节段的前凸曲度,保留了颈椎置换节段活动度,恢复了颈椎整体生物力学功能。

Objective:To observe the change of cervical curvature and range of motion(ROM)on imaging at 6 months after Hybrid surgery.Methods:A total of 29 patients with cervical degenerative disease who underwent Hybrid surgery from January 2017 to July 2018 were retrospectively analyzed.Also,they all met the inclusion criteria and had complete preoperative and 6 months postoperative imaging data.There were 11 males and 18 females,aged from 34 to 76(55.86±10.69)years,and the operation time was from 2 to 4(3.03±0.51)hours.The Cobb angle method was used to measure the changes of cervical curvature and ROM of C2-C7,replacement segments,fusion segments,and upper adjacent segments on cervical lateral X-rays before and 6 months after surgery.Results:There was no statistically significant difference in C_(2)-C_(7) curvature and ROM between 6 months after operation and before operation(P>0.05).The degree of curvature and ROM of the replacement segment increased compared with that before operation(P<0.05).The curvature of the fusion segment was increased than that before operation(P<0.05).There was no statistically significant difference in ROM of the fusion segment compared with that before operation(P>0.05).There was no statistically significant difference in the curvature and ROM of the upper adjacent segments compared with those before operation(P>0.05).There was no significant difference in the curvature between the replacement and fusion segments before and 6 months after operation(P>0.05);the ROM of the replacement segment was higher than that of the fusion segment at 6 months after operation(P<0.05).Conclusion:Hybrid surgery reconstructs the lordotic curvature of the entire cervical spine and the responsible segment,retains the ROM of the cervical replacement segment,and restores the biomechanical function of cervical spine.