矢状位参数在颈椎前路椎间盘切除减压植骨融合术治疗3节段脊髓型颈椎病中的价值

The value of sagittal parameters in anterior cervical discectomy decompression and fusion with bone grafting for treatment of three-segment cervical spondylotic myelopathy

目的探讨矢状位参数在颈椎前路椎间盘切除减压植骨融合术治疗3节段脊髓型颈椎病中的价值。方法采用颈椎前路椎间盘切除减压植骨融合术(ACDF)治疗36例3节段脊髓型颈椎病患者。比较手术前后手术节段角度(SA)、C_(2~7)Cobb角、C_(2~7)矢状位轴向距离(C_(2~7)SVA)和T_(1)倾斜角(T_(1)S),分析手术前后颈椎矢状位参数间及其与颈椎JOA评分的相关性。结果患者均获得随访,时间6~24(12.59±10.21)个月。T_(1)S、C_(2~7)Cobb角、SA、JOA评分术后均较术前明显增加(P<0.05)。C_(2~7)SVA术前与术后比较差异无统计学意义(P>0.05)。手术前后T_(1)S、C_(2~7)Cobb角、SA、JOA评分相互呈正相关关系(P<0.05)。术前C_(2~7)SVA与术前T_(1)S、C_(2~7)Cobb角、SA、JOA评分无相关关系(P>0.05)。术后C_(2~7)SVA与术后C_(2~7)Cobb角、SA、JOA评分呈负相关关系(P<0.05)。术前与术后颈椎矢状位参数间变化量的相关性分析显示,ΔT_(1)S、ΔC_(2~7)Cobb角、ΔSA与ΔJOA评分相互呈正相关关系(P<0.05),ΔC_(2~7)SVA值与ΔC_(2~7)Cobb角、ΔSA、ΔJOA评分呈负相关关系(P<0.05)。结论ACDF治疗3节段脊髓型颈椎病疗效显著,并且可以加强颈椎各矢状位参数之间的相关性,最终达到恢复颈椎矢状位参数平衡的目的。

Objective To investigate the value of sagittal parameters in anterior cervical discectomy decompression and fusion(ACDF)with bone grafting for treatment of three-segment cervical spondylotic myelopathy(CSM).Methods The 36 patients with three-segment CSM were treated by ACDF with bone grafting.The segmental angle(SA),C_(2~7) Cobb angle,C_(2~7) sagittal vertical axis(C_(2~7) SVA)and T_(1) slope(T_(1)S)were compared before and after operation,and the correlation between cervical sagittal parameters and cervical JOA score was analyzed.Results All patients were followed up for 6~24(12.59±10.21)months.T_(1)S,C_(2~7) Cobb angle,SA and JOA scores were significantly increased than the preoperation(P<0.05).C_(2~7) SVA had no statistical difference with the preoperation(P>0.05).There were mutual positive correlation for T_(1)S,C_(2~7) Cobb angle and SA,JOA score between the preopeation and postoperation(P<0.05).At the preoperation,C_(2~7) SVA was not correlated with preoperative T_(1)S,C_(2~7) Cobb angle,SA,JOA score(P>0.05),while at the postoperation,C_(2~7) SVA was negatively correlated with postoperative C_(2~7) Cobb angle,SA,JOA score(P>0.05).The correlation analysis of the changes of cervical sagittal parameters at the preoperative and postoperative showed thatΔT_(1)S,ΔC_(2~7) Cobb angle,ΔSA andΔJOA score were positively correlated mutually(P<0.05),and the value ofΔC_(2~7) SVA was negatively correlated withΔC_(2~7) Cobb angle,ΔSA andΔJOA score(P<0.05).Conclusions ACDF is effective in the treatment of three-segment CSM,and can strengthen the correlation among the sagittal parameters of cervical spine,and finally achieve the goal of restoring the balance of cervical sagittal parameters.