基于寰枢椎脱位患者的颈椎僵硬功能障碍指数量表信效度检验及其临床应用

Validation and reliability of the Cervical Stiffness Disability Index in patients with atlantoaxial dislocation and its clinical application

目的:对颈椎僵硬功能障碍指数(cervical stiffness disability index,CSDI)量表进行汉化,并检验其评估寰枢椎脱位患者颈椎僵硬度的信效度;对比后路寰枢融合术治疗单纯寰枢椎脱位与后路枕颈融合术治疗单纯寰枕融合/“三明治型”寰枢椎脱位患者的颈椎僵硬程度等临床疗效。方法:回顾性分析2017年6月~2022年6月于河北医科大学第三医院因寰枢椎脱位行后路寰枢或枕颈融合术的38例患者的临床资料,其中男性20例,女性18例,年龄50.8±10.7岁。观察指标包括颈部疼痛视觉模拟量表(visual analogue scale,VAS)评分、颈脊髓功能日本骨科协会(Japanese Orthopaedic Association,JOA)评分、北美脊柱学会(North American Spine Society,NASS)患者满意度量表、健康问卷抑郁量表(patient satisfaction scale,health questionnaire depression Scale,PHQ-9)及CSDI量表评分。汉化CSDI量表并对其进行内在一致性和重测信度检验,使用探索性因子分析法进行结构效度评价。根据NASS量表满意度是否达预期将患者分为两组,Spearman相关性分析评估各术后满意度、CSDI量表评分及观察指标间的相关性。以寰枢椎脱位亚型/术式及满意度分层进行CSDI等指标对比。结果:中文版CSDI量表具备理想信效度(Cronbach alpha=0.885,ICC=0.927)。探索性因子分析提取两个因子,累计解释了总体变异的66%,该量表具备良好结构信度。中文版CSDI量表评分与末次随访时颈部VAS疼痛评分(r=0.509,P<0.01)、JOA评分(r=-0.42,P<0.01)及抑郁情绪(r=0.549,P<0.01)中度相关。术后颈椎僵硬度的增加值与满意度中度相关(r=0.493,P<0.01)。患者满意度受末次随访时JOA评分及其改善率、颈椎僵硬程度和抑郁情绪影响。枕颈融合较寰枢融合术后轴性疼痛症状(3.2±1.1 vs 2.1±1.4,P=0.021)及颈部功能受限(38.4±15.4 vs 24.4±11.8,P=0.005)均更为显著。达预期组较未达预期组患者报告结局更佳,CSDI评分更低(22.0±12.6 vs 35.7±12.7,P=0.002)。结论:中文版CSDI量表在评估寰枢椎脱位患者颈椎僵硬度方面具备理想信效度。枕颈融合术对颈脊髓功能的改善与寰枢融合术相近,但其术后更加显著的轴性症状以及颈椎功能受限不容忽视。

Objectives:To develop a Chinese version of the Cervical Stiffness Disability Index(CSDI)scale,test its reliability and validity in evaluating cervical stiffness in patients with atlantoaxial dislocation,and to compare the clinical outcomes of posterior atlantoaxial fusion for atlantoaxial dislocation and occipitocervical fusion for combined C1 occipitalization or"sandwich fusion"atlantoaxial dislocation.Methods:The clinical data of 38 patients undergone posterior atlantoaxial or occipitocervical fusion for atlantoaxial dislocation at the Third Hospital of Hebei Medical University from June 2017 to June 2022 were retrospectively analyzed.There were 20 males and 18 females,aged 50.8±10.7 years old.The observation indexes included neck pain visual analogue scale(VAS)score,spinal cord function Japanese Orthopaedic Association(JOA)score,North American Spine Society(NASS)patient satisfaction scale,health questionnaire depression scale(PHQ-9),and CSDI score.The Chinese version of the CSDI was developed,and its internal consistency and test-retest reliability were assessed.Exploratory factor analysis was conducted to evaluate its construct validity.The patients were divided into two groups based on the satisfaction condition,as measured by the NASS scale,and Spearman correlation analysis was used to assess the relationships between postoperative satisfaction degree,CSDI score,and observational indexes.Outcome indicators such as CSDI score were analyzed through atlantoaxial dislocation subtype/procedure and satisfaction stratification comparisons.Results:The Chinese version of the CSDI demonstrated excellent reliability(Cronbach′s alpha=0.885,ICC=0.927).Exploratory factor analysis extracted two factors,explaining 66%of the total variance,indicating good construct validity of the scale.The CSDI Chinese version was moderately correlated with final follow-up cervical pain VAS score(r=0.509,P<0.01),JOA score(r=-0.42,P<0.01)and depression(r=0.549,P<0.01).The increase in postoperative cervical stiffness was moderately correlated with satisfaction(r=0.493,P<0.01).Patient satisfaction was influenced by JOA score and improvement rate at final follow-up,CSDI score,and depression.Axial symptoms(3.2±1.1 vs 2.1±1.4,P=0.021)and cervical functional limitations(38.4±15.4 vs 24.4±11.8,P=0.005)were worse after occipitocervical fusion than atlantoaxial fusion.Patients with high satisfaction reported better outcomes and lower CSDI score than those with low satisfaction(22.0±12.6 vs 35.7±12.7,P=0.002).Conclusions:The Chinese version of the CSDI scale has ideal reliability and validity in evaluating cervical stiffness in patients with atlantoaxial dislocation.Occipitocervical fusion is similar to atlantoaxial fusion in improving cervical spinal cord function,but its more significant postoperative axial symptoms and cervical spine functional limitations should not be ignored.