颈椎前路椎间盘切除、植骨融合内固定术治疗脊髓型颈椎病术后轴性症状的前瞻性研究

Prospective study of axial symptoms after anterior cervical discectomy and fusion with plating for cervical spondylotic myelopathy

中文关键词:  前路  颈椎手术  轴性症状  临床因素

英文关键词:Anterior approach  Cervical surgery  Axial symptoms  Clinical factor

中文摘要:

  【摘要】 目的：前瞻性分析若干临床因素与颈前路椎间盘切除、植骨融合内固定治疗脊髓型颈椎病术后颈部轴性症状发生的相关性。方法：2011年5月～2011年9月间接受由同一专业组术者完成的颈椎前路椎间盘切除、椎体间植骨融合、钛板内固定术患者107例，术前均无颈部疼痛、僵硬等轴性症状，均于术后3个月在门诊复查。采用日本骨科协会改良17分评分法（modified Japanese Orthopaedics Association，mJOA）改善率评价患者术后神经功能恢复情况，观察术后新出现的颈部轴性症状的发生率并使用视觉模拟评分法（visual analogue scale, VAS）评价轴性症状的程度。收集所有患者的年龄、性别、术前/术后手术节段曲度、手术节段椎间撑开高度、植骨融合情况、术后项背肌功能锻练及术后围领佩戴时间等八项临床相关因素，使用Logistic回归分析上述临床因素对术后出现颈部轴性症状的影响。使用独立样本t检验分析轴性症状与术后神经功能改善的关系。结果：本组107例患者中男性56例，女性51例，年龄29~80岁，平均52.2岁。手术节段：单节段49例（45.8%），双节段47例（43.9%），三节段11例（10.3%）。本组患者术后3个月复查时新出现的颈部轴性症状发生率为26.2%（28/107），VAS平均为4分（2~8分）。所研究的八项临床相关因素中，术后项背肌功能锻练（P=0.0003，OR=185.6）、手术节段术前曲度（P=0.003，OR=8.1）和植骨融合情况（P=0.016，OR=37.1）与术后发生颈部轴性症状有相关性。术后出现新发轴性症状患者术后mJOA评分改善率为58.6%±32.8%，未发生轴性症状患者术后mJOA改善率为65.5%±30.6%，两组结果无统计学差异（P=0.317）。结论：颈椎前路术后新发颈部轴性症状并不少见。术后项背肌功能锻炼差、术前手术节段后凸和无植骨融合迹象与术后新发轴性症状有关。

英文摘要:

  【Abstract】 Objectives: To identify clinical factors associated with the occurrence of axial symptoms following anterior cervical discectomy and fusion with plating. Methods: 107 patients diagnosed cervical spondylotic myelopathy undergoing anterior cervical discectomy and fusion with plating by the same surgeon from May 2011 to September 2011 were enrolled in this prospective study. All of the patients did not express any axial symptom such as pain or stiffness preoperatively and reviewed 3 months after surgery. New onset axial symptoms of the patients were recorded and evaluated by visual analogue scale(VAS). Eight clinical factors for each patient were collected including age, gender, the alignment of index segment(s) pre- and post-operation, the distraction of operating segment(s), the status of intervertebral bony fusion, postoperative rehabilitation, periods wearing cervical collar. The correlation among these eight clinical factors and the occurrence of axial symptoms were evaluated with Logistic regression analysis. The difference of recovery rate measured by modified Japanese Orthopaedics Association(mJOA) score between patients suffering from axial symptoms or not was analyzed by independent samples T test. Results: All patients were followed up for 3 months. The occurrence rate of axial symptoms in this study was 26.2%(28/107), with an average of 4 points VAS score. There was no statistical difference in mJOA recovery rate between patients whether appeared new onset of axial symptoms(P=0.317). Only three clinical factors including postoperative rehabilitation, the preoperative alignment of treating segment(s) and the status of intervertebral bony fusion were statistically correlated with patients′ new onset of axial symptoms(P=0.0003, 0.003, 0.016; OR=185.6, 8.1, 37.1). Conclusions: The axial symptoms following anterior cervical discectomy and fusion are not rare. Insufficient postoperative rehabilitation, the preoperative kyphosis of treating segment(s) and unsatisfied intervertebral bony fusion are correlated to the new occurrence of axial symptoms.