颈椎融合术后邻近节段退变的相关影响因素

Related factors of adjacent segment degeneration after cervical fusion surgery

中文关键词:  颈椎融合术  邻近节段退变  影响因素

英文关键词:Cervical spine fusion  Adjacent segment degeneration  Related factors

中文摘要:

  【摘要】 目的：探讨颈椎融合术后邻近节段退变（adjacent segment degeneration，ASD）的相关影响因素。方法：收集2009年1月31日~2011年1月31日在我科行颈椎前路减压植骨融合钢板内固定术治疗的患者，按照纳入和排除标准，共有235例患者纳入本研究，其中男126例，女109例，手术时年龄33～70岁，随访时间5～7年。在术前、术后1周以及末次随访时均行颈椎标准正侧位X线片及MRI检查，记录患者的年龄、性别、随访时间、融合节段数等，通过X线片测量并计算术前颈椎管率、手术前后颈椎弧弦距、钢板边缘至手术节段椎体边缘的距离（plate to disc distance，PDD）等影像学指标。根据X线片上Kellgren退变分级法和MRI上Miyazaki椎间盘退变分级法，将患者分为无ASD组和影像学ASD组。采用t检验及χ2检验比较两组间各指标的差异，用Logistic回归分析ASD的相关影响因素。结果：末次随访时共有107例患者（45.53%）出现影像学ASD。影像学ASD组患者手术时年龄为39～70岁（53.47±6.33岁），术后弧弦距为0～10.30mm（5.58±2.34mm），上、下PPD均<5mm 50例，上或下PPD<5mm 43例，上、下PPD均≥5mm 14例；无ASD组患者年龄为33～61岁（47.56±5.39岁），术后弧弦距0.10～11.21mm（7.63±2.85mm），上、下PPD均<5mm 39例，上或下PPD<5mm 62例，上、下均≥5mm 27例，两组患者手术时年龄、术后弧弦距、PDD差异均有统计学意义（P＜0.05）；两组性别比、融合节段数、术前弧弦距、术前与术后弧弦距的差值以及术前颈椎管率均无统计学差异（P＞0.05）。Logistic回归分析结果显示手术时年龄、PDD、术后弧弦距与ASD发生率均有显著相关性（P＜0.05）。结论：手术时年龄、术后颈椎弧弦距、PDD与颈椎融合术后影像学ASD显著性相关，手术时年龄越大、术后颈椎生理前凸恢复不佳以及PDD＜5mm更容易发生ASD。

英文摘要:

  【Abstract】 Objectives: To investigate the related factors of adjacent segment degeneration(ASD) after cervical fusion. Methods: 235 patients were retrospectively collected and analyzed , who underwent anterior cervical discectomy and fusion(ACDF) in our hospital from January 31, 2009 to January 31, 2011, including 126 males and 109 females. The age ranged from 33 to 70 years(mean 50.42 years). The follow-up time was from 5 to 7 years(mean, 65.32 months). Anterior cervical standard anterioposterior and lateral X-ray, MRI examination were performed before surgery, at 1 week after operation and at the final follow-up. The age, sex, the time of follow-up, fusion segment number and radiographic parameters in X-ray such as preoperative cervical spinal canal ratio, the arc chord distance of cervical spine before and after operation, plate to disc distance(PDD) were recorded. According to the X-ray Kellgren degeneration classification method and Miyazaki MRI intervertebral disc degeneration classification method, the patients were classified into non ASD group and ASD group. The differences between the two groups were compared by t-test and χ2-test, and the related influencing factors of ASD were analyzed by Logistic regression. Results: At last follow-up, 107 patients(45.53%) showed adjacent segment degeneration in the X-ray or MRI. In the ASD group, the average age was 53.47±6.33(39 to 70 years) years, the mean postoperative arc chord length was 5.58±2.34mm(0 to 10.30mm), 50 cases were with both upper and lower PDD＜5mm, 43 cases with upper or lower PDD＜5mm, 14 cases with both upper and lower PDD≥5mm. In the non ASD group, the average age was 47.56±5.39 (33 to 61 years) years, the mean postoperative arc chord length was 7.63±2.34mm(0.10 to 11.21mm), 39 cases were with both upper and lower PDD＜5mm, 62 cases with upper or lower PDD＜5mm, 27 cases with both upper and lower PDD≥5mm. Between the two groups, the differences of age, postoperative cervical arc chord distance and PDD were statistically significant(P＜0.05). Gender, fusion segment number, preoperative cervical arc chord distance, difference of the preoperative and postoperative arc chord distance, the cervical spinal canal ratio showed no statistical difference between the ASD and non ASD groups(P＞0.05). The results of Logistic regression analysis showed that age, postoperative cervical arc chord distance and PDD had significant correlations with the incidence of ASD after operation(P<0.05). Conclusions: The age, postoperative cervical arc chord distance and PDD are the risk factors of ASD after cervical fusion. Patients with older age at the time of surgery, worse recovery of cervical curvature, and PDD less than 5mm, are more likely to get ASD. Omong all, the influence of age on ASD is the greatest.