脊髓型颈椎病患者减压术后手灵活性变化的时间规律

Temporal changes of hand dexterity in patients with cervical spondylotic myelopathy after decompression surgery

中文关键词:  脊髓型颈椎病  手灵活性  患者报告的结局指标  十秒抓握试验  预测模型

英文关键词:Cervical spondylotic myelopathy  Hand dexterity  Patient-reported outcome measures  10-second Grip and Release Test  Prediction model

中文摘要:

  【摘要】 目的：探讨脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者行减压手术后1年手灵活性变化的时间规律，构建预测术后手灵活性的模型并对其加以验证。方法：前瞻性纳入2021年10月~2022年10月于我院就诊的136例成年CSM患者，男性70例，女性66例，年龄56.37±11.12岁。分别在减压术前、术后6个月及12个月时评估十秒抓握试验结果、改良日本骨科协会（the modified Japanese Orthopaedic Association，mJOA）上肢运动功能（mJOA上肢运动功能）得分和JOA颈椎病评估问卷（JOA Cervical Myelopathy Evaluation Questionnaire，JOACMEQ）上肢功能得分。通过单因素方差分析比较各参数随时间的变化情况来研究CSM患者手功能变化的时间规律。采用单因素分析及多因素Logistic回归分析，筛查影响手灵活性的潜在危险因子并构建预后模型。模型的诊断效能由受试者工作特征（receiver operating characteristic，ROC）曲线分析和曲线下面积（area under the curve，AUC）衡量。结果：在术后6个月时，患者的mJOA得分由术前的13.09±2.42分提升至16.64±1.42分、mJOA上肢运动功能得分由术前的3.90±0.89分提升至4.77±0.48分、JOACMEQ上肢功能得分由术前的76.97±19.30分提升至90.45±14.70分，十秒抓握次数由术前的14.41±3.14次增加至18.16±4.63次（P值均<0.001）；在术后12个月时，患者的十秒抓握次数进一步提升至20.00±5.25次（P=0.038），而各主观评分则未见显著变化。术前十秒抓握次数、年龄和吸烟史是术后1年手灵活性受损的独立危险因子。ROC曲线分析验证了由这三个变量构建的预测模型，其AUC为0.780（95%置信区间=0.665~0.894）。结论：衡量CSM患者手功能的主观指标在术后6个月会趋于稳定，而客观指标在1年内都有显著改善。根据患者术前十秒抓握次数、年龄和吸烟史，可预估患者1年后十秒抓握次数的恢复情况。

英文摘要:

  【Abstract】 Objectives: To elucidate the temporal pattern of hand dexterity changes in patients with cervical spondylotic myelopathy(CSM) one year after decompression surgery and to develop and validate a predictive model for hand dexterity improvement. Methods: A total of 136 adult patients with CSM(70 males and 66 females; mean age 56.37±11.12 years) treated in our hospital were prospectively enrolled between October 2021 and October 2022. Hand dexterity was assessed using the 10-second grip and release(10-s G&R) test, the modified Japanese Orthopaedic Association(mJOA) upper extremity motor function score, and the JOA cervical myelopathy evaluation questionnaire(JOACMEQ) upper extremity function before operation, and at 6 and 12 months after operation. A one-way ANOVA was conducted to examine the temporal pattern of hand function improvement. Logistic regression analysis was performed to identify risk factors and develop a predictive model for postoperative hand dexterity impairment. The model′s discrimination was assessed using receiver operating characteristic(ROC) curve and area under curve(AUC) analysis. Results: At 6 months after operation, significant improvements were observed in mJOA score(from 13.09±2.42 to 16.64±1.42分), mJOA upper extremity motor function score(from 3.90±0.89 to 4.77±0.48), JOACMEQ upper extremity function score(from 76.97±19.30 to 90.45±14.70), and 10-s G&R test result(from 14.41±3.14 cycles to 18.16±4.63 cycles)(all P<0.001); At 12 months after operation, the 10-s G&R test result further increased to 18.16±4.63 cycles(P=0.038), though no significant changes were noted in the subjective scores. The cycles of preoperative 10-s G&R test, as well as age and smoking status, were identified as the risk factors for hand dexterity impairment one year after surgery. The prediction model was validated with an AUC of 0.780(95%CI=0.665-0.894). Conclusions: Regarding the hand function of CSM patients after decompression surgery, subjective measurements typically stabilize at 6 months, while objective measurements continue to improve at 1 year. Based on the cycles of preoperative 10-s G&R test, age, and smoking status, the improvement in the cycles of the 10-s G&R test one year post-surgery can be predicted.