不同年龄分组神经根型颈椎病患者行颈椎前路椎间盘切除术后矢状面参数变化特点

doi:10.3969/j.issn.1006-7795.2023.04.019

摘要/Abstract

摘要： 目的探究不同年龄分组神经根型颈椎病患者行颈椎前路椎间盘切除术（anterior cervical discectomy and fusion, ACDF）后矢状面形态的变化及其对术后疗效的影响。方法选择2019年1月至2020年12月期间，于首都医科大学宣武医院骨科被诊断为神经根型颈椎病并接受ACDF手术的70例患者作为研究对象，记录患者的一般资料和手术资料。术前、术后以及末次随访时测量患者如下颈椎矢状面参数：枕颈角（the occipito C2 angle，OC2）、颈椎2-7前凸角（C2-7 lordosis，CL）、T1 倾斜角（T1 slope，T1S）、颈椎矢状面轴向距离（the cervical sagittal vertical axis，cSVA）和手术节段曲度（segmental angle，SA）。并分析ACDF术后颈椎矢状面参数的变化。按照年龄是否小于60岁将样本分为老年组（年龄≥60岁，n=38）和非老年组（年龄<60岁，n=32），比较两组患者ACDF术后颈椎矢状面参数变化的差异；以末次随访颈椎功能障碍指数(the neck disability index，NDI)、NDI术后改善情况，日本骨科协会改良评分(modified Japanese orthopaedic association scores，mJOA) 改善率作为预后效果评价指标，分析两组ACDF术后颈椎矢状位参数变化对预后的影响。结果术前参数相关性分析表明SA与CL、T1S呈统计学正相关，CL与OC2、T1S-CL以及cSVA呈统计学负相关，OC2与T1S-CL呈统计学正相关，T1S与cSVA呈统计学正相关。上述相关性在末次随访时同样存在。术后参数变化量的相关性分析表明△CL与△SA、△T1S呈正相关，与△T1S-CL、△cSVA呈负相关。△CL和△SA均与△T1S-CL、△cSVA呈负相关，△T1S与△T1S-CL、△cSVA呈正相关。△OC2与△cSVA呈统计学负相关。此外，与非老年组患者相比，老年组患者术后前凸角丢失更严重，并且cSVA相比于术前有增大的趋势。结论 OC2可能参与到颈椎退变以及颈椎术后恢复的矢状面代偿中。老年组患者末次随访时颈椎前凸角丢失较多，矢状面形态较差，可能与末次随访时颈椎功能评估评分较差有关。

关键词: 颈椎, 神经根型颈椎病, 矢状面形态, 老年

Abstract: Objective To evaluate the changes of the cervical sagittal alignment and the clinical effect in different age groups with cervical spondylotic radiculopathy after anterior cervical discectomy and fusion (ACDF). Method Seventy patients with cervical spondylotic radiculopathy from January 2019 to December 2020 were selected and underwent ACDF surgery. The demographic information and surgical data of the patients were recorded. The following sagittal parameters of the cervical spine were measured before operation, after operation and during the last follow-up: the occipital C2 angle (OC2), C2-7 lordosis (CL), T1 slope (T1S), the cervical sagittal vertical axis (cSVA) and segmental angle (SA). The changes of the parameters after ACDF were analyzed. The samples were divided into two groups according to whether they were less than 60 years old or not, and the differences between the elderly and the non-elderly patients were compared. The NDI (Neck Disability Index) and the improvement rate of the modified Japanese orthopaedic association scores for assessment of cervical myelopathy(mJOA) at the last follow-up were used as prognostic evaluation indexes to analyze the influence of the cervical sagittal parameters on the prognosis. Result The correlation analysis of preoperative parameters showed that SA was positively correlated with CL and T1S. CL was negatively correlated with OC2, T1S-CL and cSVA. OC2 was positively correlated with T1S-CL. T1S was positively correlated with cSVA. The above correlation also existed at the last follow-up. The correlation analysis of postoperative parameter changes showed that △CL was positively correlated with △SA and △T1S, and negatively correlated with △T1S-CL and △cSVA. △CL and △SA were negatively correlated with △T1S-CL and △cSVA, while △T1S was positively correlated with △T1S-CL and △cSVA. There was a negative correlation between △OC2 and △cSVA. In the comparison between 38 non-elderly patients (< 60) and 32 elderly patients (≥60), we found that the loss of CL was more serious in the elderly group, and cSVA has a tendency to increase after the operation. Conclusion OC2 may be involved in the sagittal compensation of the cervical degeneration and would influence the cervical postoperative recovery. The poor improvement of the sagittal alignment and the loss of cervical kyphosis angle in the elderly patients during the last follow-up may be the reason for the poor cervical function evaluation after surgery.

Key words: cervical spine, cervical spondylotic radiculopathy, sagittal alignment, elderly patients

中图分类号:

R684

史彬, 刘承鑫, 王帅康, 李翔宇, 潘福敏, 朱卫国, 鲁世保. 不同年龄分组神经根型颈椎病患者行颈椎前路椎间盘切除术后矢状面参数变化特点[J]. 首都医科大学学报, 2023, 44(4): 620-628.

Shi Bin, Liu Chengxin, Wang Shuaikang, Li Xiangyu, Pan Fumin, Zhu Weiguo, Lu Shibao. Changes of cervical sagittal parameters of patients in different age groups with cervical spondylotic radiculopathy after anterior cervical discectomy and fusion[J]. Journal of Capital Medical University, 2023, 44(4): 620-628.

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