影响颈椎后路减压内固定术治疗脊髓型颈椎病预后的影像学因素分析

The prognostic factors of cervical spondylotic myelopathy treated with posterior cervical decompression and internal fixation

中文关键词:  颈椎后路减压内固定术  脊髓型颈椎病  影像学参数  预后分析

英文关键词:Cervical posterior decompression and internal fixation  Cervical spondylotic myelopathy  Imaging parameters  Prognostic factors

中文摘要:

  【摘要】 目的：分析影响颈椎后路减压内固定术治疗脊髓型颈椎病的预后影像学因素。方法：回顾性分析2014年5月~2018年5月北部战区总医院神经外科接受颈椎后路减压内固定手术治疗脊髓型颈椎病患者的临床及影像学资料（72例），其中男55例，女17例，年龄21~80岁，平均56.9±12.0岁，收集病程、压迫节段、术前/术后1周日本骨科协会（Japanese Orthopaedic Association，JOA）评分、术前Cobb角、压迫节段内致压物最大径、有效颈椎管率、平均压迫率、脊髓横切面积、脊髓椎管占有率以及术后脊髓漂移距离、JOA改善率等相关资料。根据JOA改善率将患者分为：预后优良组（改善率≥50%）58例和预后非优良组（改善率＜50%）14例。运用单因素、多因素二元Logistic回归分析患者临床资料与影像学参数等预后相关因素，进一步绘制受试者工作特征曲线（receiver operating curve，ROC），选取尤登指数最大的数值作为划界值，明确预后相关因素临界值。结果：单因素分析显示，预后优良组术前Cobb角12.81°±4.27°，有效颈椎管率（33.71±9.87）%，脊髓漂移距离3.38±0.62mm，致压物最大径3.83±0.83mm，脊髓椎管占有率（64.02±7.74）%，与预后非优良组术前Cobb角9.68°±4.00°，有效颈椎管率（22.86±8.78）%，脊髓漂移距离2.13±0.75mm，致压物最大径5.38±1.01mm，脊髓椎管占有率（69.21±9.28）%相比，差异有统计学意义（P＜0.05）；对上述相关因素进一步多因素分析显示，致压物最大径与脊髓漂移距离是脊髓型颈椎病预后主要影响因素（P＜0.05）；ROC曲线显示，致压物最大径诊断临界值为4.950mm（曲线下面积为0.875）；脊髓漂移距离诊断临界值为2.625mm（曲线下面积为0.897）。结论：致压物最大径与脊髓漂移距离是颈椎后路减压内固定治疗脊髓型颈椎病预后的主要影响因素，且当致压物最大径超过4.950mm时，提示颈椎后路减压预后较差，术后脊髓漂移距离低于2.625mm时，提示颈椎后路减压预后不佳。

英文摘要:

  【Abstract】 Objectives: To analyze the imaging related prognostic factors of cervical spondylotic myelopathy treated with posterior cervical decompression and internal fixation. Methods: The clinical data and imaging data of 72 cases of cervical spondylotic myelopathy treated with posterior decompression and internal fixation in the neurosurgery department of Northern Theater Command general hospital from May 2014 to May 2018 were retrospectively analyzed. The patients included 55 males and 17 females, and aged from 21 to 80 years old (average, 56.9±12.0 years old). Data of disease course, compression segment, Japanese Orthopaedic Association (JOA) scores before surgery and one week after surgery, preoperative Cobb angle, maximum diameter of compressed matter in compression segment, effective cervical spinal canal rate, average compression rate, transverse area of spinal cord, spinal canal occupancy rate, spinal cord drift distance after surgery, and improvement rate of JOA were collected. According to the improvement rate of JOA, the patients were divided into the following groups: 58 cases of excellent prognosis(improvement rate ≥50%) and 14 cases of poor prognosis (improvement rate <50%). The prognostic factors were analyzed by single factor and multi-factor binary logistic regression. The receiver operating characteristic curve (ROC) was used to determine the critical value of prognosis related factors. The largest cut of Youden index was selected as the demarcation value and the critical value of prognostic factors. Results: Univariate analysis showed that there werestatistically significant differences (P<0.05) between preoperative Cobb angle of 12.81°±4.27°, effective cervical spinal canal rate of (33.71±9.87)%, spinal cord drift distance of 3.38±0.62mm, maximum diameter of compressed matter of 3.83±0.83mm, and spinal canal occupancy rate of (64.02±7.74)% in excellent prognosis group and preoperative Cobb angle of 9.68°±4.00°, effective cervical spinal canal rate of (22.86±8.78)%, spinal cord drift distance of 2.13±0.75mm, maximum diameter of compressed matter of 5.38±1.01mm, and spinal canal occupancy rate of (69.21±9.28)% in poor prognosis group. Further multivariate analysis of the above relevant factors showed that the maximum diameter of compressed matter and spinal cord drift distance were the main factors affecting the prognosis of cervical spondylotic myelopathy(P<0.05). ROC curve showed that the diagnostic critical value of the maximum diameter of compressed matter was 4.950mm(the area under the curve was 0.875). The diagnostic threshold for drift distance of spinal cord was 2.625mm(the area under curve was 0.897). Conclusions: The maximum diameter compressed matter and the drift distance of the spinal cord are the main factors influencing the prognosis of cervical spondylotic myelopathy treated by posterior decompression and internal fixation, and the prognosis is worse when the maximum diameter of compressed matter exceeds 4.950mm in the compression stage and better when the drift distance of the spinal cord exceeds 2.625mm after this operation.