脊髓型颈椎病手术治疗后的近中期JOA评分变化规律

Early and medium-term profile of modified JOA score for cervical spondylotic myelopathy after surgery

中文关键词:  脊髓型颈椎病  疗效评价  改良JOA评分

英文关键词:Cervical spondylotic myelopathy  Outcome assessment  Modified JOA score

中文摘要:

  【摘要】 目的：在回顾性队列研究中探讨脊髓型颈椎病患者手术治疗后的近中期JOA评分变化规律。方法：收集北京大学第三医院骨科于2008年2月～2011年11月收治并有完整随访资料的113例诊断为脊髓型颈椎病并接受手术治疗的患者资料。术前使用改良JOA评分（mJOA）评价患者的神经功能障碍程度，术后3个月、术后1年和末次随访时再次对患者进行mJOA评价。分析患者术后mJOA评分的变化规律，统计每例患者mJOA评分达到最大值的时间，应用Logistic回归分析不同随访时间点mJOA评分中不同部分的贡献情况。结果：本组患者随访32.7±10.8个月（24～60个月）。mJOA从术前的11.8±2.9分，改善至术后3个月的14.5±2.2分、术后1年的15.1±2.1分和末次随访时的15.2±2.3分，均较术前明显改善（P＜0.01）。mJOA达到最大值的时间为术后16.7±4.1个月（3～36个月）。Logistic回归分析结果显示mJOA评分中各部分对术后总体改善率的贡献不同：术后三次随访时，患者在感觉功能上的恢复均较运动功能和膀胱功能明显。结论：脊髓型颈椎病患者在术后近中期可以取得较好的疗效，其中以感觉功能恢复更为显著，mJOA分数在术后16.7个月达到峰值。

英文摘要:

  【Abstract】 Objectives: To investigate the short-term and mid-term profile of modified JOA(modified Japanese Orthopedic Association) score following surgery for cervical spondylotic myelopathy in a cohort study. Methods: The sample comprised 113 patients who underwent surgical treatment for cervical spondylotic myelopathy in our hospital between February 2008 and November 2011. mJOA score which was used to evaluate the neurologic dysfunction was recorded before surgery, 3 months after surgery, 1 year after surgery and at final follow-up. The feature of neurologic dysfunction before surgery and the profile of mJOA after surgery were analyzed. Each patient′s mJOA score peak time and contribution of different time points to the total mJOA score were analyzed by Logistic regression. Results: The follow-up time was 24-60 months(mean 32.7±10.8 months). The mJOA score improved from 11.8±2.9 before surgery to 14.5±2.2 at 3 months after surgery, 15.1±2.1 at 1 year after surgery, and 15.2±2.3(P＜0.01) at final follow-up. mJOA reached its maximum at 16.7±4.1 months(3-36 months) after surgery. Bivariate logistic regression showed that different part of mJOA contributed variously to the recovery rate of mJOA and motor function improvement contributed more than sensory improvement at three different follow-ups. Conclusions: Patients benefit from surgery, motor function improvement contributes more to mJOA score and mJOA reachs its maximum at 16.7 months after surgery.