退行性脊髓型颈椎病患者术前颈椎矢状面参数与临床结局的相关性

Correlation between preoperative cervical sagittal parameters and clinical outcomes in patients with degenerative cervical myelopathy

目的:分析退行性脊髓型颈椎病(DCM)患者术前颈椎矢状面参数与预后的相关性。方法:选取2017年1月至2020年5月于恩施州中心医院脊柱外科行椎板成形术治疗的102例DCM患者。记录患者术前、术后1年的C2~C7前凸(CL)、C2~C7矢状垂直轴(CSVA)、T1斜率(TS)、TS与CL差值(TS-CL)、改良的Odom标准、改良日本骨科协会(mJOA)评分和视觉模拟评分(VAS)。用mJOA评分改善情况评估DCM的恢复情况。结果:Pearson相关分析显示,术后矢状面矫正角度(CL变化,△CL)与术前CSVA、TS和TS-CL均呈负相关关系(r=-0.266、r=-0.286、r=-0.258,P<0.05)。多因素logistic回归分析显示,术前CL前凸、CSVA≥22 mm、TS-CL≥14.5°为DCM患者预后不佳的危险因素(P<0.05)。术前CSVA、术前TS-CL预测DCM患者预后不佳的受试者工作特征(ROC)曲线下面积(AUC)分别为0.720(95%CI:0.620~0.819)、0.699(95%CI:0.586~0.812)。CSVA<22.45 mm或TS-CL<21.5°DCM患者的△CL、改良的Odom分类、VAS评分改善、mJOA评分改善情况均更佳(P<0.005)。结论:椎板成形术前CSVA和TS-CL均为预测DCM患者术后CL变化及预后的有效的颈椎矢状面参数。

Objective:To analyze the correlation between preoperative cervical sagittal parameters and prognosis in patients with degenerative cervical myelopathy(DCM).Methods:A total of 102 patients with DCM who underwent laminoplasty in the Department of Spinal Surgery at Enshi Central Hospital from January 2017 to May 2020 were selected.C2-C7 lordosis(CL),C2-C7 sagittal vertical axis(CSVA),T1 slope(TS),difference between TS and CL(TS-Cl),modified Odom’scriteria,modified Japanese Orthopaedic Association(mJOA)score,and visual analog scale(VAS)score were recorded before and one year after surgery.The recovery of DCM was evaluated by mJOA recovery rate.Results:Pearson correlation analysis showed that postoperative sagittal plane correction angle(CL change,△CL)was negatively correlated with preoperative CSVA,TS and TS-Cl(r=-0.266,r=-0.286,r=-0.258,P<0.05).Multivariate logistics analysis showed that preoperative CL lordosis,CSVA≥22mm and TS-CL≥14.5 were risk factors for poor prognosis in DCM patients(P<0.05).The area under receiver operating characteristic(ROC)curve(AUC)of preoperative CSVA and preoperative TS-CL for predicting poor prognosis in DCM patients were 0.720(95%CI:0.620-0.819)and 0.699(95%CI:0.586-0.812),respectively.The△CL,modified Odom’s classification,VAS score improvement and mJOA score improvement were better in patients with CSVA<22.45mm or TS-CL<21.5°DCM(P<0.005).Conclusion:Both CSVA and TS-CL before laminoplasty are effective cervical sagittal plane parameters for predicting postoperative CL changes and prognosis in DCM patients.