术前C7/T1椎间孔面积对后路单开门椎管扩大成形术治疗脊髓型颈椎病疗效的影响

Influence of preoperative C7/T1 foraminal area on the efficacy of posterior cervical laminoplasty in the treatment of cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  C7/T1椎间孔面积  后路单开门椎管扩大成形术  轴性症状

英文关键词:Cervical spondylotic myelopathy  C7/T1 foraminal area  Posterior cervical open-door laminoplasty  Axial symptoms

中文摘要:

  【摘要】 目的：探究术前C7/T1椎间孔面积对脊髓型颈椎病患者接受后路单开门椎管扩大成形术疗效的影响。方法：回顾性分析2021年9月~2022年9月在我院因脊髓型颈椎病行后路单开门椎管扩大成形术治疗的76例患者，其中男58例、女18例，年龄为64.4±8.5岁。于患者术前颈椎双斜位X线片上测量C7/T1椎间孔面积，根据C7/T1椎间孔面积分为两组：A组，C7/T1椎间孔面积≤平均值（40例），B组，C7/T1椎间孔面积大于平均值（36例）。收集并比较两组患者的手术时间、术中出血量，两组患者的术前、术后3个月、术后12个月的JOA评分，计算JOA改善率；记录两组患者术后12个月的轴性症状发生情况，采用T检验、方差分析及卡方检验分析术前不同C7/T1椎间孔面积的患者接受颈后路单开门手术治疗后是否存在疗效的差异性。结果：C7/T1椎间孔面积A组为35.2±9.7mm2，B组为65.7±13.1mm2；术前C2~C7 Cobb角A组为14.0°±3.6°，B组为16.0°±5.5°，两组间椎间孔面积和C2~C7 Cobb角有统计学差异（P＜0.05）。手术时间A组127.5±23.6min，B组120.3±32.6min；出血量A组176.8±88.2mL，B组183.6±100.2mL，两组间均无统计学差异（P＞0.05）。术前JOA评分A组10.9±2.0分，B组10.3±2.1分，两组间无统计学差异（P>0.05）。术后3个月JOA评分A组12.8±1.5分，B组14.0±2.2分；术后12个月JOA评分A组14.1±1.5分，B组15.9±1.7分，两组间有统计学差异（P<0.05）。术后3个月、12个月JOA评分改善率两组间有统计学差异（P<0.05）。A、B两组术后12个月的轴性症状发生率分别为42.5%和19.4%，有统计学差异（P<0.05）。结论：术前C7/T1椎间孔面积较大的患者后路单开门椎管扩大成形术后神经功能的恢复更好，JOA改善率更高，术后轴性症状的发生率更低。

英文摘要:

  【Abstract】 Objectives: To investigate the effects on the efficacy of posterior cervical laminoplasty in patients with cervical spondylotic myelopathy of different C7/T1 foraminal areas before surgery. Methods: 76 patients who underwent posterior cervical open-door expansive laminoplasty for cervical spondylotic myelopathy in our hospital from September 2021 to September 2022 were analyzed retrospectively, including 58 males and 18 females, aged 64.4±8.5 years old. The area of C7/T1 foramina of patients was measured on the double oblique X-ray images before operation, and the patients were divided into two groups on the basis of the average C7/T1 foraminal area: Group A, C7/T1 foraminal area≤average value(40 patients), and group B, C7/T1 foraminal area>average value(36 patients). The operative time and intraoperative bleeding were collected and compared between groups, and the Japanese Orthopaedic Association(JOA) scores before surgery, 3 months after surgery, and 12 months after surgery were obtained to calculate the JOA score improvement rate; The axial symptoms at 12 months after surgery were recorded, and T test, analysis of variance, and chisquare test were used to analyze whether different preoperative C7/T1 forminal areas of patients affected the efficacies after posterior cervical laminoplasty. Results: The foraminal areas of C7/T1 was 35.2±9.7mm2 in group A and 65.7±13.1mm2 in group B, and C2-C7 Cobb angle before operation was 14.0°±3.6° in group A and 16.0°±5.5° in group B, with statistical differences respectively(P＜0.05). Group A was not significantly different from group B in terms of intraoperative bleeding(176.8±88.2mL vs 183.6±100.2mL) and operative time(127.5±23.6min vs 120.3±32.6min)(P>0.05). The JOA scores of group A and group B were 10.9±2.0 and 10.3±2.1 before operation, without statistical difference(P>0.05); The JOA scores of group A and group B were 12.8±1.5 and 14.0±2.2 at postoperative 3 months and 14.1±1.5 and 15.9±1.7 at 12 months after operation, with statistical differences respectively(P<0.05). There were statistical differences in the improvement rates of JOA scores between the two groups at postoperative 3 months and 12 months, respectively(P<0.05). The incidence of axial symptoms 12 months after operation in group A and group B was 42.5% and 19.4%, respectively, with statistical difference(P<0.05). Conclusions: Patients with larger C7/T1 foraminal area have better postoperative neurological recovery, higher rate of JOA improvement, and lower incidence of postoperative axial symptoms.