颈椎后路单开门椎管扩大成形后发生C_(2)、C_(3)椎弓骨撞击:2年内颈椎侧位X射线片评估

C_(2)andC_(3) vertebral arch bone impact after posterior cervical single open-door laminoplasty:lateral X-ray evaluation of cervical spine within 2 years

背景:颈后路单开门椎板成形后易出现C_(2)、C_(3)椎弓骨撞击的现象,导致患者术后颈椎活动受限,对其相关因素分析具有重要的临床意义。目的:分析颈椎后路单开门椎管扩大成形后C_(2)、C_(3)椎弓骨撞击的相关因素,探讨术后C_(2)、C_(3)椎弓骨撞击的病因及发病机制。方法:回顾性分析行颈椎后路单开门椎管扩大成形并有完整随访资料的多节段脊髓型颈椎病患者95例,平均年龄(56.76±7.76)岁,男性33例,女性62例。术后随访观察2年内颈椎侧位X射线片是否发生C_(2)、C_(3)椎弓骨性撞击,分为撞击组31例、非撞击组64例。经过单因素分析,提示术前合并后纵韧带骨化、术后颈椎曲度、术后颈椎活动度、术后目测类比评分为术后C_(2)、C_(3)椎弓骨撞击发生的潜在相关因素,最后纳入多变量Logistic回归分析。结果与结论:①95例患者中31例发生C_(2)、C_(3)椎弓骨撞击,占33%;②撞击组术前合并后纵韧带骨化的发生率明显大于非撞击组(P<0.05);③撞击组与非撞击组术前颈椎曲度、颈椎活动度、日本矫形外科学会(JOA)评分、目测类比评分比较无统计学意义(P>0.05);撞击组术后颈椎曲度、颈椎活动度显著低于非撞击组(P<0.05);末次随访时,两组日本矫形外科学会(JOA)评分无显著性意义(P>0.05),撞击组目测类比评分显著高于非撞击组(P<0.05);④术后发生轴性症状撞击组2例(6%),非撞击组3例(5%);⑤多元素Logisic回归分析表明:术后颈椎曲度低、颈椎活动度低、目测类比评分高均为术后C_(2)、C_(3)椎弓骨性撞击发生的独立危险因素;结果提示C_(2)、C_(3)椎弓骨撞击是轴性症状发生的重要原因之一,C_(2)、C_(3)椎弓骨撞击对术后疗效有一定影响。

BACKGROUND:The phenomenon of C_(2)andC_(3)vertebral arch bone impact is easy to occur after posterior cervical single open-door laminoplasty,which leads to the limitation of postoperative cervical movement.The analysis of related factors is of great clinical significance.OBJECTIVE:To analyze the related factors of C_(2)andC_(3)vertebral arch bone impact after posterior cervical single open-door laminoplasty,and to explore the etiology and pathogenesis of C_(2)andC_(3)vertebral arch bone impact.METHODS:A retrospective analysis was performed in 95 patients with multi-level cervical spondylotic myelopathy who underwent posterior cervical single open-door laminoplasty and had complete follow-up data,at a mean age of(56.76±7.76)years old,including 33 males and 62 females.The patients were followed up to observe whether C_(2)andC_(3)vertebral arch bone impact occurred within 2 years using X-ray films.The patients were divided into impact group(n=31)and non-impact group(n=64).After univariate analysis,it suggested that preoperative ossification of posterior longitudinal ligament,postoperative cervical curvature,postoperative cervical mobility,and postoperative visual analogue scale score were the potential related factors of C_(2)andC_(3)vertebral arch bone impact.Finally,multivariable logistic regression analysis was included.RESULTS AND CONCLUSION:(1)Among 95 patients,31 cases had C_(2)andC_(3)vertebral arch bone impact,accounting for 33%.(2)The incidence of preoperative ossification of the posterior longitudinal ligament in the impact group was significantly higher than that in the non-impact group(P<0.05).(3)There was no statistical significance in the preoperative cervical curvature,cervical motion range,Japanese Orthopaedic Association score,and visual analogue scale between the impact group and the non-impact group(P>0.05).Cervical curvature and cervical motion range were significantly higher in the impact group than those in the non-impact group(P<0.05).At the final follow-up,Japanese Orthopaedic Association score was not significantly different between the impact group and the non-impact group(P>0.05).Visual analogue scale score was significantly higher in the impact group than that in the non-impact group(P<0.05).(4)Postoperative axial symptoms occurred in 2 cases(6%)in the impact group and 3 cases(5%)in the non-impact group.(5)Multivariable logistic regression analysis suggested that low postoperative cervical curvature,low postoperative cervical motion range,and high postoperative visual analogue scale score were independent risk factors for C_(2)andC_(3)vertebral arch bone impact.It is indicated that C_(2)andC_(3)vertebral arch bone impact is one of the important reasons for the occurrence of axial symptoms and has a certain impact on the postoperative curative effect.