前路颈椎间盘切除椎间融合术患者术后颈托佩戴时间对康复效果的影响

Effects of cervical collar wearing time on rehabilitation after anterior cervical discectomy and fusion

目的探讨前路颈椎间盘切除椎间融合术(ACDF)患者术后颈托佩戴的时间对康复效果的影响。方法回顾性分析2016年1月—2017年12月入住首都医科大学宣武医院神经外科脊柱组行1~2节段ACDF的97例颈椎病患者,按照术后实际颈托佩戴时间分为1~4周组(39例)、5~8周组(22例)、9~12周组(36例)。比较三组患者术前、术后3个月的日本骨科协会评分(JOA)、颈椎轴性症状评分(AS)、颈部功能障碍指数(NDI)的差异。结果三组患者术后的JOA评分较术前均改善,差异有统计学意义(P<0.05),但术前及术后三组间差异无统计学意义(P>0.05)。术后佩戴1~4周组和5~8周组患者的AS评分与术前比较,差异无统计学意义(P>0.05),而9~12周组的术后AS评分较术前下降,差异有统计学意义(P<0.05);术后三组间的AS评分比较,差异有统计学意义(P<0.05)。三组患者术后的NDI较术前均改善,差异有统计学意义(P<0.05);佩戴5~8周组NDI改善效果优于1~4周组,差异有统计学意义(P<0.05)。结论行1~2节段ACDF患者的轴性症状发生率随着颈托佩戴时间的增长有所增加,颈托佩戴时间为5~8周颈椎康复效果最佳,患者的功能障碍指数最低,且未显著增加患者轴性症状。

Objective To explore the effect of the wearing time of cervical collar on the rehabilitation of patients with anterior cervical discectomy and fusion(ACDF).Methods The data of 97 patients with cervical spondylosis who were admitted to the Neurosurgery Spine Group of Xuanwu Hospital of Capital Medical University and underwent 1-2 segment ACDF from January 2016 to December 2017 were retrospectively analyzed.According to the wearing time of cervical collar after operation,the patients were divided into 1-4 weeks group(39 cases),5-8 weeks group(22 cases),and 9-12 weeks group(36 cases).The scores of the Japanese Orthopaedic Association Score(JOA),Axial Symptom Score(AS),and Neck Disability Index(NDI)were compared among the three groups before operation and 3 months after operation.Results The postoperative JOA scores of the three groups were improved compared with those before the operation,and the differences were statistically significant(P<0.05);however,there was no significant difference among the three groups before operation and 3 months after operation(P>0.05).Compared with preoperative,the postoperative AS scores in 1-4 weeks group and 5-8 weeks group has no significant difference(P>0.05),but the AS score of the 9-12 weeks group decreased compared with that before operation,and the difference was statistically significant(P<0.05).After operation,the difference of AS scores among three groups was statistically significant(P<0.05).The postoperative NDI scores of the three groups were improved compared with those before operation,and the differences were statistically significant(P<0.05).The improved effect of NDI in the 5-8 weeks group was better than that in the 1-4 weeks group,and the difference was statistically significant(P<0.05).Conclusions The incidence of axial symptoms in patients with 1-2 segment ACDF increases with the wearing time of cervical collar.The cervical collar wearing time for 5 to 8 weeks has the best effect,the patients have the lowest disability index,and did not significantly increase the patients'axial symptoms.