颈后路双开门椎管扩大椎板成形自体棘突植骨术后颈椎矢状面形态学观察

Cervical curvature after double-door laminoplasty and autologous spinous process graft

中文关键词:  颈椎病  椎管狭窄  自体棘突骨  双开门  矢状面形态

英文关键词:Cervical Spondylosis, Spinal Stenosis, Autologous Spinous, Double-door Laminoplasty, Sagittal Morphology

中文摘要:

  【摘要】 目的：观察颈后路双开门椎管扩大椎板成形自体棘突骨植骨术对颈椎矢状面形态学的影响。方法：选择2006年1月~2014年6月接受C3~C7颈后路双开门椎管扩大椎板成形术自体棘突植骨且具有完整影像学资料的患者共57例，年龄62.2±7.4岁（44~73岁），其中后纵韧带骨化症24例（男15例，女9例），多节段脊髓型颈椎病33例（男20例，女13例）。在颈椎X线片上测量枕骨入射角（OI）、枕骨斜率（OS）、枕骨倾斜角（OT）、上颈椎前凸角（C0-C2角）、下颈椎前凸角（C2-C7角）、颈椎前凸角（C0-C7角）、颈椎矢状面轴向垂直距离（C2-C7 SVA）、颈椎活动度（ROM）和T1倾斜角（T1-Slope）。对所有患者进行日本骨科协会（JOA）颈髓功能评分，计算改善率。采用独立样本t检验对上述指标进行比较，并行Pearson相关性分析。结果：术中、术后均无并发症发生，随访时间13.6±9.3个月，其中56例患者术后1年时植骨明确融合。术前JOA评分10.9±2.7分，末次随访时为14.1±2.1分，较术前平均增加3.2±2.4分（P<0.01）；JOA评分改善率为（53.1±21.7）%。末次随访与术前比较，OI、OS和OT无显著性差异（P>0.05）；C0-C2角、C0-C7角、C2-C7 SVA、T1-Slope均显著增加（P<0.05）；颈椎ROM显著降低（P<0.01）。术前与末次随访的OI值与对应的C0-C2角有显著相关性（r=0.542，P=0.014；r=0.479，P=0.027）。结论：颈后路双开门椎管扩大椎板成形自体棘突骨植骨术后枕颈部矢状面无明显变化，但颈椎前倾，上颈椎前凸角度增加，颈椎活动度降低，T1倾斜角度增加。

英文摘要:

  【Abstract】 Objectives: To explore the sagittal morphology of cervical spine after double-door laminoplasty and autologous spinous process graft in cervical myelopathy. Methods: A total of 57 patients were recruited in this study, who underwent double-door laminoplasty and autologous spinous process graft from January 2006 to June 2014, including 24 patients with ossified posterior longitudinal ligament and 33 patients with multilevel cervical spondylotic myelopathy. All the parameters measured on the lateral radiographs of cervical spine were recorded before operation and at the final follow-up . The occipitocervical parameters and cervical spine sagittal parameters were as follows: occipital incidence(OI), occipital slope(OS), occipital tilt(OT), C0-C2 angle, C2-C7 angle, C0-C7 angle, C2-C7 sagittal vertical axis(SVA), range of motion(ROM) and thoracic 1 slope(T1-slope). Pre- and postoperative neurological status was evaluated by using the Japanese Orthopaedic Association(JOA) scoring system for cervical myelopathy. All the parameters were compared between preoperation and the final follow-up by independent sample t test and Pearson correlation analysis. Results: There was no complication found intraoperatively or postoperatively. The average follow-up time was 13.6±9.3 months. JOA score was 10.9±2.7 at preoperation, which was significantly lower than that at final follow-up(14.1±2.1, P<0.01). After operation, the JOA score had improved 40.0%-83.3%(average 53.1%). Occipitocervical parameters between the two time points were not significantly different(P>0.05). However, significant correlation was observed between OI and C0-C2 angle in the two time points(r=0.542, P=0.014 vs r=0.479, P=0.027). C0-C2 angle, C2-C7 angle, C0-C7 angle, C2-C7 SVA and T1 slope were significantly higher at final follow-up than those at preoperation(P<0.05), while ROM was significantly lower postoperatively. Conclusions: There is no significant difference in occipitocervical parameters between preoperation and final follow-up after double-door laminoplasty and autologous spinous process graft. However, the occipitocervical parameters are correlated with the upper cervical sagittal alignment. The sagittal cervical curvature changes postoperatively: leaning forward of cervical spine, higher cervical lordosis, lower cervical sagittal vertical axis, and higher T1 slope.