目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定...目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者,其中男11例,女7例,年龄52.3±8.1岁;颈椎后纵韧带骨化症(ossification of posterior longi-tudinal ligament,OPLL)合并慢性颈脊髓病5例,脊髓型颈椎病13例.减压节段:17例为C3~C7,1例为C3~T1,术中固定融合3.8±1.0个椎体.12例患者出院时(术后2周左右)复查颈椎MRI,11例患者获得随访,随访时间2.1~13.5年(10.5±2.8年).在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角,在颈椎MRI上测量脊髓前缘角及改良K线,末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况.术前及末次随访时进行JOA评分及颈痛VAS评分.结果:18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸,术后2周为3.8°±8.0°前凸,有显著性差异(P<0.01);术前C2~C7颈椎Cobb角为1.3°±9.4°前凸,术后2周为5.8°±7.0°前凸,无显著性差异(P>0.05).12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸,术后2周为1.3°±5.2°后凸,有显著性差异(P<0.01);C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸,术后2周为1.1°±6.3°前凸,有显著性差异(P<0.01).7例(39%)患者术后出现C5神经根麻痹,均在术后1~4个月内完全恢复.术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合,后凸矫形角度无丢失;颈椎MRI显示脊髓无受压,正中矢状位片显示脊髓前缘角无丢失.11例患者JOA评分术前8.0±2.8分,末次随访时15.6±0.9分,有显著性差异(P<0.01),JOA评分改善率(83±14)%;颈痛VAS评分术前为2.2±3.0分,末次随访时为1.11.2分,术前与末次随访时相比无显著�展开更多
Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surger...Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.0展开更多
文摘目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者,其中男11例,女7例,年龄52.3±8.1岁;颈椎后纵韧带骨化症(ossification of posterior longi-tudinal ligament,OPLL)合并慢性颈脊髓病5例,脊髓型颈椎病13例.减压节段:17例为C3~C7,1例为C3~T1,术中固定融合3.8±1.0个椎体.12例患者出院时(术后2周左右)复查颈椎MRI,11例患者获得随访,随访时间2.1~13.5年(10.5±2.8年).在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角,在颈椎MRI上测量脊髓前缘角及改良K线,末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况.术前及末次随访时进行JOA评分及颈痛VAS评分.结果:18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸,术后2周为3.8°±8.0°前凸,有显著性差异(P<0.01);术前C2~C7颈椎Cobb角为1.3°±9.4°前凸,术后2周为5.8°±7.0°前凸,无显著性差异(P>0.05).12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸,术后2周为1.3°±5.2°后凸,有显著性差异(P<0.01);C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸,术后2周为1.1°±6.3°前凸,有显著性差异(P<0.01).7例(39%)患者术后出现C5神经根麻痹,均在术后1~4个月内完全恢复.术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合,后凸矫形角度无丢失;颈椎MRI显示脊髓无受压,正中矢状位片显示脊髓前缘角无丢失.11例患者JOA评分术前8.0±2.8分,末次随访时15.6±0.9分,有显著性差异(P<0.01),JOA评分改善率(83±14)%;颈痛VAS评分术前为2.2±3.0分,末次随访时为1.11.2分,术前与末次随访时相比无显著�
文摘Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.0
