摘要
目的研究零切迹椎间融合器(Zero-Profile interbody fusion device,Zero-P)行单节段颈前路减压融合术(anterior cervical decompression and fusion,ACDF)后,胸1倾斜角(T_1Slope,T_1S)与融合器沉降发生的关系。方法回顾性分析2011年5月至2015年8月我院采用Zero-P置入治疗的49例颈椎间盘突出症病人的临床资料,其中男25例,女24例,年龄为33~68岁,平均(45.86±7.95)岁。在病人手术前后的颈椎侧位X线片上测量颈椎前凸角(cervical lordosis,CL)、T_1S、手术节段前凸角(segmental angle,SA)、颈椎矢状位垂直轴(cervical sagittal vertical axis,c SVA)、手术节段高度(segmental height,SH);采用疼痛视觉模拟量表(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)评价临床效果。采用统计学分析各矢状位参数与临床疗效的关系以及融合器发生沉降的危险因素。结果本组随访24~75个月,平均48.3个月。术后及末次随访的T_1S、SA角度大小与VAS评分呈负相关,T_1S、SA、CL角度大小与NDI呈负相关。融合器沉降的发生与术后NDI呈负相关。发生融合器沉降与未发生沉降病例的CL、T_1S、SA值比较,差异均有统计学意义(P均<0.05)。纳入多因素Logistic回归分析后发现,术前T_1S大小是融合器沉降发生的独立危险因素。应用ROC分析截断值为18°(曲线下面积=0.787,敏感度=0.737,特异度=0.733,P=0.004),术前T_1S≤18°的病人的融合器沉降率是T_1S>18°的病人的7.7倍(P=0.001)。结论应用Zero-P系统行单节段ACDF,术前T_1S≤18°的病人术后发生融合器沉降的风险较高。
Objective To determine the relationship between the degree of the T1 slope（T1 S） and theincidence of cage subsidence following one-level ACDF with Zero-P. Methods We retrospectively analyzed49 patients（male∶female, 25∶24; mean age, 45.86±7.95 years old） who underwent one-level ACDF with Zero-Pfrom May 2011 to August 2015. Parameters including cervical lordosis（CL）, T1 S, cervical sagittal vertical axis（c SVA）, segmental angle（SA）, and segmental height（SH） on plane radiographs were measured. VAS and NDIwere used to analyze clinical outcomes. Risk factors of subsidence were determined using multivariate logisticregression. Results The mean clinical follow-up was 48.3 months（range 24-75 months）. The angles of T1 S, SAand CL were correlated with clinical outcomes. The occurrence of subsidence was negatively correlated withoutcomes. There were significant differences in pre-operative angles of CL, T1 S and SA between subsidence andnon-subsidence group. Multivariate logistic regression analysis revealed that there was a strong correlationbetween pre-operative T1 S and cage subsidence. A cutoff value of T1 S ≤18° significantly predicted subsidence（sensitivity： 73.7%; specificity： 73.3%, P=0.004） and lower T1 S was associated with higher risk of subsidence（LR=7.7, P=0.001）. Conclusion A lower T1 S（T1 S ≤18°） could be a risk factor of subsidence following one-level ACDF with Zero-P.
作者
解放
凃志鹏
龚克
黄培培
孙畅
胡学昱
罗卓荆
XIE Fang;TU Zhi-peng;GONG Ke;HUANG Pei-pei;SUN Chang;HU Xue-yu;LUO Zhuo-jing(Department of Orthopaedics, Xijing Hospital, Air Force Medical University, xi＇an 710032,china)
出处
《骨科》
CAS
2018年第3期206-211,共6页
ORTHOPAEDICS
基金
国家自然科学基金(81371947)
