摘要
目的探讨颈椎前路减压融合术(anterior cervical decompression and fusion,ACDF)治疗的节段数量对寰枢椎的影响及相关因素分析。方法连续性收集并回顾性分析2016年12月至2018年12月共126例接受ACDF手术的颈椎病患者资料,其中男59例,女67例,年龄(54.3±8.4)岁(范围:40~79岁)。126例根据颈椎病的类型分为:神经根型60例,脊髓型41例和混合型25例。根据手术节段数量分为:单节段手术组20例;双节段手术组45例;多节段手术组61例,包括3节段51例、4节段10例。分别于术前1周、术后3个月及术后1年对所有患者行颈椎标准侧位、过屈过伸位X线片检查,并分别进行临床疗效评价及颈椎矢状位参数测量,其中临床疗效评价包括日本骨科学会评分(Japanese Orthopaedic Association,JOA)、疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)。颈椎矢状位参数包括C2-7、C0-1、C1-2曲度和活动度以及枢椎斜坡角度(C2Slope)。结果126例随访时间(25.6±7.2)个月(范围:14~38个月)。单节段、双节段和多节段组手术时间分别为(86.4±15.5)、(117.6±15.6)、(170.2±28.7)min,术中出血量分别为(16.5±5.2)、(37.2±30.5)、(63.4±41.5)ml,差异均有统计学意义(P<0.05)。术后3个月、1年与术前比较,单、双节段组上颈椎曲度、活动度及枢椎斜坡角度差异无统计学意义(P>0.05)。多节段组术后寰枕关节活动度由术前11.5°±6.1°增至术后3个月的16.1°±13.9°和术后1年的15.3°±4.8°,上颈椎曲度、枢椎斜坡角度分别由术前21.0°±7.6°、6.1°±6.7°减至术后3月18.6°±7.7°、4.3°±6.9°和术后1年19.7°±7.2°、5.6°±6.3°,差异均有统计学意义(P<0.05)。术后1年上颈椎曲度及枢椎斜坡角度向术前水平恢复,寰枕关节曲度与术前差异无统计学意义(P>0.05)。结论单、双节段ACDF对于前凸曲度维持效果更好,且对上颈椎无显著影响,但多节段融合会影响前凸曲度
Objective To explore sagittal parameters change of upper cervical spine after anterior cervical decompression and fusion(ACDF)and analyze the influential factors by comparison between single-,double-and multi-level surgery.Methods In this retrospective study,126 patients(include 60 patients with radiculopathy,41 patients with myelopathy and 25 patients with myeloradiculopathy)who underwent ACDF between December 2016 and December 2018,were followed up at least 1year ranged from14 to 38 months,with the average of 25.6±7.2 months.20 patients were operated by single-level ACDF,45 patients were operated by double-level ACDF and 61 patients were operated by 3-or 4-level ACDF.Standing radiographs of cervical spine and the flexion and extension cervical X-rays were obtained in all patients at 1week before,3 months after and 1year after operation.The Japanese Orthopaedic Association(JOA)Scores,visual analogue scale(VAS)and neck disability index(NDI)were used to evaluate the clinical effectiveness.Cervical sagittal parameters were assessed with the following parameters:the platform angle of axis(C2Slope),the cobb angle and the range of motion(ROM)of C2-7,C0-1 and C1-2.Results All the patients obtained satisfactory clinical effects.The mean operative time of single-,double-and multi-level group were 86.4±15.5 min,117.6±15.6 min and 170.2±28.7 min,respectively.The intraoperative blood loss of 3 groups were 16.5±5.2 ml,37.2±30.5 ml and 63.4±41.5 ml,respectively.There was statistically significant difference between the 3 groups(P<0.05).In the single-and double-level groups,the changes of the cobb angle and ROM of upper cervical spine between 1 week before operation and 1 year after operation was no significant difference(P>0.05).In the multi-level group,the ROM of atlantooccipital joint(C0-1)increased significantly from 11.5°±6.1°before operation to 16.1°±13.9°3 months and 15.3°±4.8°1 year after operation(P<0.05).The cobb angle of upper cervical spine and C2Slpoe was decreased significantly from 21.0°±7.6°,
作者
肖博威
刘宝戈
吴炳轩
崔维
桑大成
王典
余帆
Xiao Bowei;Liu Baoge;Wu Bingxuan;Cui Wei;Sang Dacheng;Wang Dian;Yu Fan(Department of Orthopaedic Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第18期1235-1244,共10页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81972084)
国家自然科学基金(81772370)
国家重点研发计划科技冬奥专项(2018YFF0301103)
北京市医院管理局临床医学发展专项(XMLX201803)。
关键词
颈椎病
脊柱融合术
颈寰椎
枢椎
对比研究
Cervical spondylosis
Spinal fusion
Cervical atlas
Axis
Comparative study
