颈椎后路单开门椎板成形与颈椎体次全切除植骨融合治疗多节段颈椎病对颈椎矢状位平衡参数的影响

Effects of posterior single open-door laminoplasty and anterior cervical corpectomy fusion on cervical sagittal balance parameters in the treatment of multilevel cervical spondylotic myelopathy

背景:颈椎后路单开门椎管扩大椎板成形(posterior single open-door laminoplasty,LAMP)及颈椎椎体次全切除植骨融合(anterior cervical corpectomy fusion,ACCF)均可有效治疗脊髓型颈椎病,但两种治疗方式对患者术后颈椎矢状位平衡有不同的影响。目的:对比两种方法治疗多节段脊髓型颈椎病对颈椎矢状位平衡参数的影响。方法:选择2017年8月至2020年8月蚌埠医学院第一附属医院收治的多节段脊髓型颈椎病患者70例,其中进行LAMP治疗30例,进行ACCF治疗40例。术前及术后随访时拍摄颈椎侧位X射线片,对比两组患者C_(2-7)颈椎前凸角、C_(2-7)矢状面轴向距离及T_(1)倾斜角。试验获得蚌埠医学院第一附属医院伦理委员会批准。结果与结论:(1)与术前比较,两组患者术后随访10个月的T_(1)倾斜角无明显变化(P>0.05);两组间术后10个月的T_(1)倾斜角比较差异无显著性意义(P>0.05);(2)与术前比较,ACCF组患者术后10个月的C_(2-7)Cobb角增大(P<0.05),LAMP组患者术后10个月的C_(2-7)Cobb角减小(P<0.05);ACCF组患者术后10个月的C_(2-7)Cobb角大于LAMP组(P<0.05);(3)与术前比较,ACCF组患者术后10个月的C_(2-7)矢状面轴向距离减少(P<0.05),LAMP组患者术后10个月的C_(2-7)矢状面轴向距离增加(P<0.05);ACCF组患者术后10个月的C_(2-7)矢状面轴向距离小于LAMP组(P<0.05);(4)在ACCF组中,高T_(1)倾斜角患者术后C_(2-7)Cobb角、C_(2-7)矢状面轴向距离变化值与低T1倾斜角患者比较差异无显著性意义(P>0.05);在LAMP组中,高T_(1)倾斜角患者术后C_(2-7)Cobb角、C_(2-7)矢状面轴向距离变化值均大于低T_(1)倾斜角患者(P<0.05);(5)结果表明,相较于LAMP,ACCF治疗多节段脊髓型颈椎病可以避免颈椎后凸畸形、更好地保持颈椎生理曲度、改善颈椎矢状位平衡;为了避免术后颈椎矢状位平衡失代偿,ACCF更适合高T1倾斜角脊髓型颈椎病的治疗。

BACKGROUND:Posterior single open-door laminoplasty(LAMP)and anterior cervical corpectomy fusion(ACCF)can effectively treat cervical spondylotic myelopathy.However,the two treatments have different effects on the postoperative cervical spine sagittal balance.OBJECTIVE:To compare the effects of LAMP and ACCF on cervical sagittal balance parameters in the treatment of multilevel cervical spondylotic myelopathy.METHODS:Seventy patients with multilevel cervical spondylotic myelopathy in First Affiliated Hospital of Bengbu Medical College from August 2017 to August 2020 were enrolled in this study.There were 40 cases in ACCF group and 30 cases in LAMP group.Lateral cervical X-ray films were taken before operation and during follow-up.C_(2-7) Cobb angle,C_(2-7) sagittal vertical axis,and T_(1) inclination angle were compared between the two groups.This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College.RESULTS AND CONCLUSION:(1)Compared with preoperatively,there was no significant change in the T_(1) inclination angle between the two groups at 10 months after surgery(P>0.05).There was no significant difference between the two groups in the T_(1) inclination angle at the 10-month postoperative period(P>0.05).(2)Compared with preoperatively,the C_(2-7) Cobb angle of patients in the ACCF group increased at 10 months after surgery(P<0.05),and the C_(2-7) Cobb angle of patients in the LAMP group decreased at 10 months after surgery(P<0.05).The C_(2-7) Cobb angle of patients in the ACCF group was greater than that of the LAMP group at 10 months after surgery(P<0.05).(3)Compared with preoperatively,C_(2-7) sagittal vertical axis in the ACCF group decreased at 10 months after the operation(P<0.05),and C_(2-7) sagittal vertical axis increased in the LAMP group at 10 months after the operation(P<0.05).The C_(2-7) sagittal vertical axis of the ACCF group was smaller than that of the LAMP group at 10 months after surgery(P<0.05).(4)In the ACCF group,the postoperative C_(2-7) Cobb angle and C_(2-7) sagittal vertical axis changes in patients with high T_(1) inclination angle were not significantly different from those in patients with low T_(1) inclination angle(P>0.05).In the LAMP group,the changes of C_(2-7) Cobb angle and C_(2-7) sagittal vertical axis in patients with high T_(1) inclination angle were greater than those in patients with low T_(1) inclination angle(P<0.05).(5)The findings showed that compared with LAMP,ACCF in the treatment of multilevel cervical spondylotic myelopathy can avoid cervical kyphosis,better maintain the physiological curvature of the cervical spine and improve the sagittal balance of the cervical spine.To avoid postoperative sagittal balance decompensation of cervical vertebra,ACCF is more suitable than LAMP for the treatment of cervical spondylotic myelopathy with high T_(1) inclination angle.