术前颈椎矢状位形态对退行性颈椎病患者ACDF术后神经功能改善的预测价值

Predictive value of preoperative sagittal alignment of cervical spine on the improvement of neurological function after ACDF in patients with degenerative cervical disease

目的分析术前颈椎矢状位形态(CSA)对退行性颈椎病(degenerative cervical disease,DCD)患者颈椎前路间盘切除植骨融合术(ACDF)术后神经功能改善的预测价值。方法选取接受ACDF手术治疗的DCD患者280例,检测术前颈椎矢状位参数,术后6个月统计神经功能改善情况。用Logistic回归模型分析DCD患者ACDF术后神经功能改善不良的影响因素;绘制受试者工作特征曲线(ROC)分析术前颈椎矢状位参数对DCD患者ACDF术后神经功能改善不良的预测价值。结果DCD患者ACDF术后神经功能改善优良率80.00%;Logistic回归模型显示,年龄、症状持续时间、C_(2)~C_(7) Cobb角、C_(2)~C_(7)矢状面垂直轴(SVA)、T_(1)S是DCD患者ACDF术后神经功能改善不良的影响因素(P<0.05);ROC曲线显示,C_(2)~C_(7) Cobb角、C_(2)~C_(7) SVA、T_(1)S单独及联合预测ACDF的AUC分别为0.790、0.740、0.771、0.867。结论C_(2)~C_(7) Cobb角、C_(2)~C_(7) SVA、T_(1)S是DCD患者ACDF术后神经功能改善不良的影响因素,三者联合检测具有较高的预测价值。

Objective To analyze the predictive value of preoperative sagittal alignment of cervical spine on the improvement of neurological function after anterior cervical discectomy and fusion(ACDF)in patients with degenerative cervical disease(DCD).Methods A total of 280 DCD patients who underwent ACDF were selected.The preoperative sagittal alignment parameters of cervical spine were measured.The improvement of neurological function was evaluated at 6 months after surgery.Logistic regression model was used to analyze the influencing factors of poor neurological function improvement after ACDF in DCD patients.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of preoperative sagittal alignment parameters on poor neurological function improvement after ACDF in DCD patients.Results The excellent-good rate of neurological function improvement after ACDF in DCD patients was 80.00%.Logistic regression model analysis showed that age,duration of symptoms,C_(2)~C_(7) Cobb angle,C_(2)~C_(7) sagittal vertical axis(SVA),and T1S were influencing factors of poor neurological function improvement after ACDF in DCD patients(P<0.05).ROC curve showed that the AUCs for C_(2)~C_(7) Cobb angle,C_(2)~C_(7) SVA,T1S alone and combined were 0.790,0.740,0.771,and 0.867,respectively.Conclusion C_(2)~C_(7) Cobb angle,C_(2)~C_(7) SVA,and T1S are influencing factors of poor neurological function improvement after ACDF in DCD patients.The combination of these three parameters has a high predictive value.