后路寰枢椎融合术后下颈椎前凸曲度降低的影响因素研究

Study on influencing factors of reduced lordotic curvaturein lower cervical spine after posterior atlantoaxial fusion

目的探讨后路寰枢椎融合术后下颈椎前凸曲度降低的影响因素。方法选择2016年4月~2018年4月本院收治的84例寰枢椎脱位患者为研究对象,均采用后路寰枢椎融合术治疗,随访2年,根据术前、术后的下颈椎前凸角变化设为降低组以及不变或增加组,比较两组患者年龄、性别、术前枕颈角、下颈椎前凸角、颈椎矢状面轴向垂直距离(C_(2-7)sagittal vertical axis,C_(2-7)SVA)、T_(1)倾斜角(T_(1)slope,T_(1)S)、术后C_(1-2)角等临床资料,采用Logistic回归分析法调查术后下颈椎前凸曲度降低的独立影响因素。结果术后下颈椎前凸曲度降低者26例,不变或增加者58例。两组患者年龄、术前枕颈角、下颈椎前凸角、C_(2-7)SVA、术后C 1-2角差异有统计学意义(P<0.05);两组患者性别、术前T_(1)S差异无统计学意义(P>0.05)。Logistic回归分析显示,年龄≥60岁、术前下颈椎前凸角>20°、术前枕颈角>20°、术后C 1-2角>20°,均是术后下颈椎前凸曲度降低的独立影响因素。结论后路寰枢椎融合术后下颈椎前凸曲度降低与术前下颈椎前凸角、术前枕颈角、年龄以及融合角度过大有关。

Objective To explore the influencing factors ofreduced lordotic curvature in the lower cervicalspine after posterior atlantoaxial fusion.Methods Eighty-four patients with atlantoaxial dislocation from April 2016 to April 2018 were selected as the study subjects,alltreated with posterior atlantoaxial fusion and followed up for two years.They were divided into the decreased group and the unchanged or increased group according to the preoperative and postoperative changes of the lower cervical lordosis angle.The clinical data of two groups of patients,namely,age,gender,preoperative occipital neck angle,inferior cervical lordosis angle,C_(2-7)sagittal vertical axis(C_(2-7)SVA),T_(1) slope(T_(1)S),postoperative C_(1-2)angle and other clinical data,were compared.Results Among 84 cases of atlantoaxial dislocation patients with posterior approach atlantoaxial fusion,26 caseshad lower cervical lordosis curvature and58 cases were unchanged or increased.Differences in age,occipital neck angle,kyphotic angle of lower cervical spine,C_(2-7)SVA,and C_(1-2)angle after operation were statistically significant between the two groups(P<0.05).There was no significant difference in gender and preoperative T_(1)S between the two groups(P>0.05).Logistic regression analysis showed that the age was≥60 years old,the preoperative lower cervical spine kyphosis angle>20°,the preoperative occipital neck angle>20°,the postoperative C_(1-2)angle>20°were independent factors of reduced lordotic curvature in the lower cervicalspine after posterior atlantoaxial fusion.Conclusion The reduction of lordotic curvature in the lower cervical spine after posterior atlantoaxial fusion is related to the preoperative lower cervical lordosis angle,preoperative occipital neck angle,age,and excessive fusion angle.