C3-7单开门椎管扩大成形术后颈椎矢状位序列的变化及其与颈椎功能的相关性

Sagittal alignment changes of cervical spine in patients with cervical spondylotic myelopathy after cervical 3-7 single-door laminoplasty and its correlation with functional status of cervical spine

中文关键词:  单开门椎管扩大成形术  颈椎矢状位序列  颈椎功能  相关性分析

英文关键词:Cervical spondylotic myelopathy  Sagittal parameters of cervical spine  Laminoplasty  visual analog scale  modified Japanese Orthopaedic Association

中文摘要:

  【摘要】 目的：探究颈椎单开门椎管扩大成形术后全颈椎矢状位序列的变化，探讨颈椎矢状位序列变化的意义及其与患者颈椎功能状态的关系。方法：回顾性分析我院2015年1月~2018年7月收治的脊髓型颈椎病患者164例，其中男性95例，女性69例，年龄64.8±18.3（48~86）岁。随访时间22.7±11.3（9~46）个月。所有患者均行C3-7后路单开门椎管扩大成形术。在患者术前和末次随访的颈椎侧位X线片上测量颈椎矢状位序列参数：C1-2 Cobb 角、C2-7 Cobb角、颈椎弧弦距（cervical arc chord distance，CACD）、颈倾角（cervical tilting，CERT）、颅倾角（cranial tilting，CRAT）、颈总角（cervical global alignment，CGA）、T1倾斜角（thoracic 1 slope，T1S），C7倾斜角（C7 slope，C7S）和C2-7矢状垂线轴（C2-7 sagittal vertical axis，SVA）。记录入组患者术前及末次随访时颈痛视觉模拟评分（visual analog scale，VAS）及改良日本骨科协会评分（modified Japanese Orthopaedic Association，mJOA）评分，采用配对样本t检验比较手术前后各参数的变化，Pearson相关性分析颈椎矢状位序列参数变化之间的相关性及与颈椎功能状态评分（颈痛VAS、mJOA评分）的相关性。结果：颈椎单开门椎管扩大成形术后T1S较术前减小1.25°±3.34°（21.38°±7.54° vs 20.13°±7.16°，P=0.004），C7S较术前减小0.44°±4.23°（28.05°±7.72° vs 27.61°±7.81°，P=0.012），C2-7 Cobb角较术前减小5.51°±6.88°（15.92°±12.57° vs 10.40°±10.93°，P<0.001），CACD较术前减小1.50±3.92mm（6.94±5.69mm vs 5.44±5.52mm，P=0.003），CERT较术前减小2.23°±5.27°（13.45°±6.37° vs 11.22°±6.78°，P=0.001），C2-7 SVA较术前增大3.35±9.90mm（18.20±9.05mm vs 21.55±10.65mm，P=0.009），C1-2 Cobb角较术前增大2.06°±5.09°（39.56°±0.46° vs 41.62°±0.70°，P=0.002）。末次随访VAS（1.52±1.47分）显著高于术前（1.02±1.12分，P=0.007）。Pearson相关性分析显示C2-7 SVA、CACD、CGA、C2-7 Cobb角、C1-2 Cobb角、CERT、CRAT的变化相互之间有显著统计相关性（P<0.05）。手术前后VAS的变化与C2-7 SVA（r=0.462，P<0.001）、C1-2 Cobb角（r=0.362，P<0.01）及CRAT（r=0.323，P<0.01）的变化呈正相关，与CGA（r=-0.316，P<0.01）及CACD变化（r=-0.344，P<0.01）呈负相关，mJOA评分手术前后的变化与C2-7 SVA（r=0.273，P<0.05）及C1-2 Cobb角（r=0.298，P<0.05）的变化呈正相关。结论：C3-7单开门椎管扩大成形术后出现下颈椎生理曲度变直，头部重心位置前移，上颈椎及颈胸段脊柱过伸。C3-7单开门椎管扩大成形术后轴性症状加重与颈椎矢状位序列的变化有关。

英文摘要:

  【Abstract】 Objectives: To investigate the changes of sagittal alignment of the cervical spine after C3-7 single-door laminoplasty, and to explore its relationship with the functional status of cervical spine after laminoplasty. Methods: Retrospectively reviewed data of 164 patients between January 2015 and July 2018. There were 95 males and 69 females with an average age of 64.8±18.3(48-86) years. Follow up time: 22.7±11.3(9-46) months. Inclusion criteria: patients diagnosed of cervical spondylotic myelopathy. Exclusion criteria: previous history of spinal surgery, history of tumors, history of cervical trauma, sagittal spinal imbalance, scoliosis, spine infection. The C2-7 sagittal vertical axis(C2-7 SVA), cervical 1-2 Cobb angle, cervical 2-7 Cobb angle, cervical arc chord sistance(CACD), cervical tilting(CERT), cranial inclination(Cranial Tilting, CRAT), cervical global alignment(CGA), thoracic 1 slope(T1S) and cervical 7 slope(C7S) were measured and recorded using PACs 3.0 system. The neck pain visual analog scale(VAS) and modified Japanese Orthopaedic Association(mJOA) score before operation and at final follow-up were recorded. All data were analyzed by SPSS 24.0 software. Results: Compared with preoperative, T1S decreased by 1.25±3.34(21.38°±7.54° vs 20.13°±7.16°, P=0.004), C7S decreased by 0.44°±4.23°(28.05°±7.72° vs 27.61°±7.81°, P=0.012), C2-7 Cobb angle decreased by 5.51°±6.88°(15.92°±12.57° vs 10.40°±10.93°, P<0.001), CACD decreased by 1.50±3.92mm(6.94±5.69mm vs 5.44±5.52mm, P=0.003), CERT decreased by 2.23°±5.27°(13.45°±6.37° vs 11.22°±6.78°, P=0.001), C2-7 SVA increased by 3.35±9.90mm(18.20±9.05mm vs 21.55±10.65mm, P=0.009), C1-2 Cobb angle increased by 2.06°±5.09°(39.56°±0.46° vs 41.62°±0.70°, P=0.002), VAS (1.52±1.47) at final follow-up was significantly higher than that before operation(1.02±1.12)(P=0.007). Pearson correlation analysis showed that the changes of C2-7 SVA, CACD, CGA, C2-7 Cobb angle, C1-2 Cobb angle, CERT and CRAT were significantly correlated with each other(P<0.05). The difference of VAS before and after surgery were positively correlated with the difference of C2-7 SVA(r=0.462, P<0.001), C1-2 Cobb angle(r=0.362, P<0.01) and CRAT (r=0.323, P<0.01), and negatively correlated with the difference of CGA(r=-0.316, P<0.01) and CACD (r=-0.344, P<0.01). The changes of mJOA score before and after operation were positively correlated with the changes of C2-7 SVA(r=0.273, P<0.05) and C1-2 Cobb angle(r=0.298, P<0.05). Conclusions: The sagittal alignment of cervical spine in patients with cervical spondylotic myelopathy changed significantly after C3-7 single-door laminoplasty, including kyphotic changes of the lower cervical spine, forward tilting of gravity center of cervical spine, and overextension of the upper cervical spine and cervicothoracic spine. These changes were not only due to the influence of the cervical posterior structuraldamage, but also the compensatory mechanism. The deterioration of axial symptoms after cervical laminoplasty is related to the change of sagittal alignment of cervical spine.