颈椎前路椎间盘切除融合术后颈椎矢状位参数变化及其对临床疗效的影响
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摘要
目的探讨颈椎间盘突出症病人行颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion, ACDF)后颈椎矢状位参数变化及其对临床疗效的影响。方法选取2014年1月至2016年1月在我院接受ACDF手术治疗的颈椎间盘突出症病人98例,对其临床资料进行回顾性分析。其中,男50例,女48例;年龄为(54.75±8.60)岁(40~78岁)。收集比较98例病人术前及随访时的C_(2-7) Cobb角、T_1倾斜角、C_(2-7) 矢状面轴向距离(cSVA)、颈倾角(NTA)、胸廓入口角(TIA)等矢状位参数,以及其手术前后的颈肩臂疼痛视觉模拟量表(visual analogue scale, VAS)评分、日本骨科学会(Japanese Orthopaedic Association, JOA)评估治疗分数、颈椎功能障碍指数(neck disability index, NDI)。98例病人根据T_1倾斜角是否大于30°分为高T_1倾斜角组和低T_1倾斜角组,比较两组病人的JOA评分改善率及后凸畸形发生率。结果本研究所观察的矢状位参数中,术后T_1倾斜角、C_(2-7) Cobb角较术前显著增大,NTA、cSVA较术前显著减小;功能相关指标中,VAS评分较术前显著下降,JOA评分显著上升,与术前比较,差异均有统计学意义(P均<0.05)。高T_1倾斜角组和低T_1倾斜角组的JOA治疗改善率(56.06%vs. 53.12%)及后凸畸形发生率(12.50%vs. 16.67%)比较,差异均有统计学意义(χ~2=12.538,P=0.001;χ~2=10.895,P=0.003)。且高T_1倾斜角组病人中,单节段、双节段、多节段病人的后凸畸形发生率均显著低于低T_1倾斜角组,差异均有统计学意义(P均<0.05)。结论 ACDF治疗颈椎间盘突出症的短期临床疗效确切,T_1倾斜角>30°病人的JOA治疗改善率较高,后凸畸形发生率较低。
Objective To investigate the changes of sagittal parameters of cervical spine after anteriorcervical discectomy and fusion(ACDF) in patients with cervical disc herniation and its effect on clinicalefficacy. Methods Ninety-eight patients with cervical disc herniation treated by ACDF from January 2014 toJanuary 2016 in our hospital were selected and their clinical data were analyzed retrospectively. Among them,there were 50 males and 48 females with age of(54.75±8.60) years old(40-78 years). Sagittal parameters suchas C_(2-7)Cobb angle, T_1 tilt angle, C_(2-7)sagittal axial distance(cSVA), neck tilt angle(NTA), thoracic entranceangle(TIA) and visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score, neckdisability index(NDI) were collected and compared in 98 patients before and after surgery. Ninety-eightpatients were divided into high T_1 tilt angle group and low T_1 tilt angle group according to whether the T_1 tiltangle was greater than 30°. The improvement rate of JOA score and the incidence of kyphosis were comparedbetween the two groups. Results Among the sagittal parameters observed in this study, T_1 tilt angle and C_(2-7)Cobb angle increased significantly after surgery, while NTA and cSVA decreased significantly after surgery.Among the function-related indicators, VAS score decreased significantly and JOA score increased significantlyafter treatment as compared with those before operation(P<0.05 for all). The improvement rate of JOA score(56.06% vs. 53.12%) and the incidence of kyphosis deformity(12.50% vs. 16.67%) in high T_1 tilt angle groupand low T_1 tilt angle group were significantly different(χ~2=12.538, P=0.001; χ~2=10.895, P=0.003). In high T_1 tiltangle group, incidence of kyphosis in patients with single, double and multiple segments was significantly lowerthan that in low T_1 tilt angle group(P<0.05 for all). Conclusion The short-term clinical efficacy of ACDF inthe treatment of cervical disc herniation is definite, and the improvement rate of JOA score in patients with T_1 tilt angle >30° is more obvious, with lower kyphosis incidence.
Objective To investigate the changes of sagittal parameters of cervical spine after anteriorcervical discectomy and fusion(ACDF) in patients with cervical disc herniation and its effect on clinicalefficacy. Methods Ninety-eight patients with cervical disc herniation treated by ACDF from January 2014 toJanuary 2016 in our hospital were selected and their clinical data were analyzed retrospectively. Among them,there were 50 males and 48 females with age of(54.75±8.60) years old(40-78 years). Sagittal parameters suchas C_(2-7)Cobb angle, T_1 tilt angle, C_(2-7)sagittal axial distance(cSVA), neck tilt angle(NTA), thoracic entranceangle(TIA) and visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score, neckdisability index(NDI) were collected and compared in 98 patients before and after surgery. Ninety-eightpatients were divided into high T_1 tilt angle group and low T_1 tilt angle group according to whether the T_1 tiltangle was greater than 30°. The improvement rate of JOA score and the incidence of kyphosis were comparedbetween the two groups. Results Among the sagittal parameters observed in this study, T_1 tilt angle and C_(2-7)Cobb angle increased significantly after surgery, while NTA and cSVA decreased significantly after surgery.Among the function-related indicators, VAS score decreased significantly and JOA score increased significantlyafter treatment as compared with those before operation(P<0.05 for all). The improvement rate of JOA score(56.06% vs. 53.12%) and the incidence of kyphosis deformity(12.50% vs. 16.67%) in high T_1 tilt angle groupand low T_1 tilt angle group were significantly different(χ~2=12.538, P=0.001; χ~2=10.895, P=0.003). In high T_1 tiltangle group, incidence of kyphosis in patients with single, double and multiple segments was significantly lowerthan that in low T_1 tilt angle group(P<0.05 for all). Conclusion The short-term clinical efficacy of ACDF inthe treatment of cervical disc herniation is definite, and the improvement rate of JOA score in patients with T_1 tilt angle >30° is more obvious, with lower kyphosis incidence.
引文
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[8]Janusz P, Tyrakowski M, Glowka P, et al. Influence of cervicalspine position on the radiographic parameters of the thoracic inletalignment[J]. Eur Spine J, 2015, 24(12):2880-2884.
[9]Gillis CC, Kaszuba MC. Cervical radiographic parameters in 1-and2-level anterior cervical discectomy and fusion[J]. J NeurosurgSpine, 2016, 25(4):421-429.
[10]Lee CK, Shin DA, Yi S, et al. Correlation between cervical spinesagittal alignment and clinical outcome after cervical laminoplastyfor ossification of the posterior longitudinal ligament[J]. J Neuro-surg Spine, 2016, 24(1):100-107.
[11]Hyun SJ, Kim KJ, Jahng TA, et al. Relationship between T1 slopeand cervical alignment following multilevel posterior cervical fu-sion surgery:impact of T1 slope minus cervical lordosis[J]. Spine(Phila Pa 1976), 2016, 41(7):E396-E402.
[12]Tang JA, Scheer JK, Smith JS, et al. The impact of standing re-gional cervical sagittal alignment on outcomes in posterior cervicalfusion surgery[J]. Neurosurgery, 2015, 76(Suppl 1):S14-S21.
[13]林圣荣,周非非,孙宇,等.颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化[J].中华医学杂志, 2014, 94(35):2726-2730.
[14]Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inletalignment on the craniocervical sagittal balance in asymptomaticadults[J]. J Spinal Disord Tech, 2012, 25(2):E41-E47.
[15]许浩,李锋,廖晖,等.颈椎动态稳定器治疗颈椎病的短期疗效观察[J].骨科, 2016, 7(4):225-229.
[16]杨永波,朱振军,杨希望,等.两种颈前路手术方式治疗双节段颈椎病[J].中国矫形外科杂志, 2016 24(7):594-597.
[17]孙鹏飞,谢雁春,张昊聪,等.颈椎前路减压椎间融合器置入对椎间孔孔径的影响[J].中国脊柱脊髓杂志, 2018, 28(1):52-56.
[18]Anakwenze OA, Auerbach JD, Milby AH, et al. Sagittal cervicalalignment after cervical disc arthroplasty and anterior cervical dis-cectomy and fusion:results of a prospective, randomized, con-trolled trial[J]. Spine, 2009, 34(19):2001-2007.
[19]Litrico S, Lonjon N, Riouallon G, et al. Adjacent segment diseaseafter anterior cervical interbody fusion:a multicenter retrospectivestudy of 288 patients with long-term follow-up[J]. Orthop Trauma-tol Surg Res, 2014, 100(6 Suppl):S305-S309.
[20]Zhang JT, Li JQ, Niu RJ, et al. Predictors of cervical lordosisloss after laminoplasty in patients with cervical spondylotic my-elopathy[J]. Eur Spine J, 2017, 26(4):1205-1210.
[2]Kim JH, Park JY, Yi S, et al. Anterior cervical discectomy and fu-sion alters whole-spine sagittal alignment[J]. Yonsei Med J, 2015,56(4):1060-1070.
[3]Gottipati P, Stine R, Ganju A, et al. The effect of positive sagittalspine balance and reconstruction surgery on standing balance[J].Gait Posture, 2018, 62:227-234.
[4]张浩,周文超,陈元元,等.颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系[J].中国脊柱脊髓杂志, 2016, 26(3):206-210.
[5]Makhni MC, Shillingford JN, Laratta JL, et al. Restoration of sagit-tal balance in spinal deformity surgery[J]. J Korean NeurosurgSoc, 2018, 61(2):167-179.
[6]解放,凃志鹏,龚克,等.零切迹椎间融合器行单节段颈前路减压融合术后T1倾斜角与融合器沉降的关系研究[J].骨科,2018, 9(3):206-211.
[7]Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittalbalance of spondylolisthesis:a review and classification[J]. EurSpine, 2011, 20(Suppl 5):641-646.
[8]Janusz P, Tyrakowski M, Glowka P, et al. Influence of cervicalspine position on the radiographic parameters of the thoracic inletalignment[J]. Eur Spine J, 2015, 24(12):2880-2884.
[9]Gillis CC, Kaszuba MC. Cervical radiographic parameters in 1-and2-level anterior cervical discectomy and fusion[J]. J NeurosurgSpine, 2016, 25(4):421-429.
[10]Lee CK, Shin DA, Yi S, et al. Correlation between cervical spinesagittal alignment and clinical outcome after cervical laminoplastyfor ossification of the posterior longitudinal ligament[J]. J Neuro-surg Spine, 2016, 24(1):100-107.
[11]Hyun SJ, Kim KJ, Jahng TA, et al. Relationship between T1 slopeand cervical alignment following multilevel posterior cervical fu-sion surgery:impact of T1 slope minus cervical lordosis[J]. Spine(Phila Pa 1976), 2016, 41(7):E396-E402.
[12]Tang JA, Scheer JK, Smith JS, et al. The impact of standing re-gional cervical sagittal alignment on outcomes in posterior cervicalfusion surgery[J]. Neurosurgery, 2015, 76(Suppl 1):S14-S21.
[13]林圣荣,周非非,孙宇,等.颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化[J].中华医学杂志, 2014, 94(35):2726-2730.
[14]Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inletalignment on the craniocervical sagittal balance in asymptomaticadults[J]. J Spinal Disord Tech, 2012, 25(2):E41-E47.
[15]许浩,李锋,廖晖,等.颈椎动态稳定器治疗颈椎病的短期疗效观察[J].骨科, 2016, 7(4):225-229.
[16]杨永波,朱振军,杨希望,等.两种颈前路手术方式治疗双节段颈椎病[J].中国矫形外科杂志, 2016 24(7):594-597.
[17]孙鹏飞,谢雁春,张昊聪,等.颈椎前路减压椎间融合器置入对椎间孔孔径的影响[J].中国脊柱脊髓杂志, 2018, 28(1):52-56.
[18]Anakwenze OA, Auerbach JD, Milby AH, et al. Sagittal cervicalalignment after cervical disc arthroplasty and anterior cervical dis-cectomy and fusion:results of a prospective, randomized, con-trolled trial[J]. Spine, 2009, 34(19):2001-2007.
[19]Litrico S, Lonjon N, Riouallon G, et al. Adjacent segment diseaseafter anterior cervical interbody fusion:a multicenter retrospectivestudy of 288 patients with long-term follow-up[J]. Orthop Trauma-tol Surg Res, 2014, 100(6 Suppl):S305-S309.
[20]Zhang JT, Li JQ, Niu RJ, et al. Predictors of cervical lordosisloss after laminoplasty in patients with cervical spondylotic my-elopathy[J]. Eur Spine J, 2017, 26(4):1205-1210.