颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系

Relationship between clinical outcomes and changes of cervical sagittal alignment after cervical expansive door-open laminoplasty in ossification of posterior longitudinal ligament

中文关键词:  颈椎后纵韧带骨化症  单开门椎管成形术  矢状序列  临床疗效

英文关键词:Ossification of posterior longitudinal ligament  One-door-open laminoplasty  Sagittal alignment  Clinical outcome

中文摘要:

  【摘要】 目的：探讨颈椎后纵韧带骨化症（OPLL）患者行颈后路单开门椎管扩大成形术后颈椎矢状位参数变化与手术疗效的关系。方法：选取2009年1月～2013年1月在我院接受颈后路单开门椎管扩大成形术的OPLL患者68例，随访12～30个月。记录手术前后JOA（Japanese Orthopaedic Association）评分、颈肩臂疼痛VAS（visual analog scale）评分，计算神经功能JOA改善率（improvement rate，IR）。术前、术后和随访时行颈椎正侧位X线片、CT三维重建和MRI检查，测量术前及随访时的颈椎矢状位参数，包括C2-C7 Cobb角、C2-C7矢状面轴向距离（sagittal vertical axis，SVA）和T1倾斜角。结果：末次随访时JOA评分及VAS评分较术前明显改善（P<0.001），神经功能恢复为优者21例，良30例，中14例，差3例，优良率为75%。末次随访时C2-C7 Cobb角由术前的15.4°±9.5°增大到17.4°±10.2°，但差异无统计学意义（P=0.166）；C2-C7 SVA由术前的21.0±15.3mm增大到27.0±15.7mm，差异有统计学意义（P=0.009）；T1倾斜角由术前的30.2°±10.1°增大到33.7°±8.0°，差异有统计学意义（P=0.044）。术前T1倾斜角与C2-C7 Cobb角正相关（r=0.569，P<0.01），与C2-C7 SVA正相关（r=0.544，P<0.01）。C2-C7 Cobb角与C2-C7 SVA无显著相关性（r=0.05，P=0.798）。末次随访时C2-C7 Cobb角较术前增大24例，较术前减小44例，两组JOA评分和VAS评分变化、神经功能改善率无统计学差异；C2-C7 SVA增加46例，减小22例，两组JOA评分和VAS评分变化、神经功能改善率亦无统计学差异（P>0.05）。结论：颈后路单开门椎管扩大成形术治疗OPLL短期疗效确切，手术前后颈椎矢状参数的变化与患者的临床疗效无显著相关性。

英文摘要:

  【Abstract】 Objectives: To analyze the relationship between the changes of cervical spine sagittal alignment and clinical outcomes after cervical expansive door-open laminoplasty in patients with ossification of posterior longitudinal ligament(OPLL). Methods: 68 patients with OPLL who underwent cervical expansive door-open laminoplasty between January 2009 and January 2013 were analyzed in this study. All the patients were followed up from 12 to 30 months. Outcome assessment JOA scores, VAS scores were obtained in all patients preoperatively, postoperatively and at last follow-up, the JOA improvement rate(IR) was also calculated. Standing radiographs of cervical spine, CT(3D) and MRI were obtained preoperatively, postoperatively and at last follow-up. Cervical spine alignment was assessed with the following 3 parameters: C2-C7 Cobb angle, C2-C7 sagittal vertical axis(SVA) and T1 slope. Results: At last follow-up, VAS and JOA scores improved significantly(P<0.001) when compared with the preoperative scores, the JOA improvement rate was excellent in 21 cases, good in 30 cases, middle in 14 cases and poor in 3 cases, the excellent rate was 75%. C2-C7 Cobb angle increased from 15.4°±9.5° preoperatively to 17.4°±10.2° at last follow-up, but there was no significant difference(P=0.166); C2-C7 SVA increased from 21.0±15.3mm to 27.0±15.7mm, the difference was significant(P=0.009); T1 slope angle increased from 30.2°±10.1° to 33.7°±8.0°, the difference was significant(P=0.044). There was a linear correlation and positive correlation between T1 slope angle and C2-C7 Cobb angle(r=0.569, P<0.01), T1 slope angle and C2-C7 SVA(r=0.544, P<0.01) preoperatively. At last follow-up, C2-C7 Cobb angle increased in 44 patients and decreased in 24 patients, C2-C7 SVA angle increased in 46 patients and decreased in 22 patients. However, the improvements of JOA and VAS scores were not significant different between the patients who had increased C2-C7 Cobb angle and patients who had decreased C2-C7 Cobb angle, the patients who had increased C2-C7 SVA angle and patients who had decreased C2-C7 SVA(P>0.05). Conclusions: Neurological function improves after expansive door-open laminoplasty in patients with OPLL, but the cervical alignment changes after surgery are not significantly correlated with the clinical outcomes.