颈椎后路单开门椎管扩大成形术对患者术后颈椎矢状面平衡的影响

Effect of posterior cervical single open-door expansive laminoplasty on sagittal plane balance of cervical spine of patients after operation

目的:观察颈椎后路单开门椎管扩大成形术后患者颈椎矢状面平衡的变化,为患者术后康复训练提供影像学依据。方法:选择接受颈椎后路单开门椎管扩大成形术患者32例,根据术前矢状位轴向距离(SVA)值的中位数(15.75 mm)将患者分为低SVA组和高SVA组,每组16例。对2组患者术前及末次随访的影像学及临床资料进行回顾性分析,检测术前及术后末次随访时患者颈椎X线侧位片SVA值、颈椎前凸角(Cobb角)和T1倾斜角(T1s),分析2组患者术后日本骨科协会(JOA)评分、颈椎残障功能指数(NDI)评分和满意度评分。结果:与术前比较,术后高SVA组患者NDI评分降低(P<0.01),JOA评分升高(P<0.01)。与术前比较,术后低SVA组患者NDI评分降低(P<0.01),JOA评分升高(P<0.01),SVA值升高(P<0.01),Cobb角和T1s差异无统计学意义(P>0.05)。低SVA组和高SVA组患者轴性症状发生率比较差异无统计学意义(P>0.05)。结论:在术后至少2年的随访中,颈椎后路单开门椎管扩大椎板成形术对患者颈椎矢状面平衡有一定影响,主要表现为颈椎有前倾趋势和重心前移,但整体稳定性尚可,术前高SVA患者术后轴性症状发生率更高。

Objective:To observe the changes of sagittal plane balances of cervical spine of the patients underwent posterior cervical single open-door expansive laminoplasty,and to provide the imaging evidence for the postoperative rehabilitation training of the patients.Methods:A total of 32 patients who underwent posterior cervical single open-door expansive laminoplasty were selected.According to the median value(15.75 mm)of sagittal vertical axis(SVA)distance before operation,the patients were divided into low SVA group and high SVA group,and there were 16 patients in each group.The imaging and clinical data of the patients in two groups before operation and at the last follow-up were retrospectively analyzed.The SVA value,cervical lordosis angle(Cobb angle),and T1 tilt angle(T1s)of the patients at the X-ray lateral view of the cervical spine were detected before operation and at the last follow-up.The postoperative Japanese Orthopaedic Association(JOA)score,neck disability index(NDI)store,and satisfaction score of the patients in two groups were analyzed.Results:Compared with before operation,the NDI score of the patients in high SVA group after operation was decreased(P<0.01),the JOA score was increased(P<0.01).Compared with before operation,the NDI score of the patients in low SVA group was decreased(P<0.01),the JOA score was increased(P<0.01),and the SVA value was increased(P<0.01),while there were no significant differences in the Cobb angle and T1s(P>0.05).There was no statistically significant difference in the occurrence of axial symptoms of the patients between low SVA group and high SVA group(P>0.05).Conclusion:In the follow-up of at least 2 years after operation,posterior cervical single open-door expansive laminoplasty has the certain effect on the sagittal plane balance of cervical spine of the patients.The main manifestations are tendency of cervical lordosis and anterior shift of the center of gravity,but the overall stability can still be maintained.The patients with high SVA have a higher incidence of axial symptoms after operation.