颈椎单开门椎管扩大椎板成形微型钢板内固定术后轴性疼痛的危险因素

Risk factors of axial pain after unilateral open-door cervical laminoplasty with mini-plate fixation

中文关键词:  颈椎单开门椎管扩大椎板成形术  轴性疼痛  微型钢板  多因素分析  颈椎活动度  关节突关节

英文关键词:Cervical laminoplsty  Axial symptoms  Mini-plate  Multivariate analysis  Cervical ROM  Facet joints

中文摘要:

  【摘要】 目的：探讨颈椎单开门椎管扩大椎板成形微型钢板内固定术后轴性疼痛的危险因素。方法：回顾性分析2008年12月~2016年3月219例在我院行颈椎单开门椎管扩大椎板成形微型钢板内固定术患者的临床资料，其中男176例，女43例，年龄31~89岁（60.7±12.3岁）。根据术后是否发生轴性疼痛，分为轴性疼痛组和无轴性疼痛组。对两组患者性别、年龄、症状持续时间、诊断类型、内科合并症情况、手术节段、术中出血量、手术时长、术前术后神经功能、颈椎稳定性、颈椎序列分型、颈椎曲度、椎管矢状径、颈椎活动度、颈后伸肌群面积、门轴愈合情况、关节突关节完整性等指标进行单因素分析，根据单因素分析结果进一步进行多元Logistic回归分析。结果：共有63例患者术后出现轴性疼痛，156例患者无轴性疼痛，两组患者术后神经功能均较术前均明显改善，两组改善率无统计学差异（P>0.05）。单因素分析显示术前颈肩疼痛、术后颈椎稳定性、术后颈椎序列分型、术后颈椎曲度变化、术后颈椎活动度变化、关节突关节破坏等指标与术后轴性痛发生可能相关（P<0.1），纳入多因素分析。多因素分析显示术后颈椎活动度的变化（P=0.047）和关节突关节破坏（P=0.041）与术后轴性疼痛的发生相关。结论：颈椎活动度减少和微型钢板固定螺钉对关节突关节的破坏是颈椎单开门椎管扩大椎板成形微型钢板固定术后轴性疼痛发生的危险因素，术中应注意保护关节突关节，减少对颈后肌群的破坏。

英文摘要:

  【Abstract】 Objectives: To detect the risk factors of axial pain by multivariate analysis in cervical laminoplasty with mini-plate fixation. Methods: A total of 219 patients who underwent cervical laminoplasty with mini-plate fixation was reviewed from December 2008 to March 2016. Patients were divided into two groups: patients with and patients without postoperative axial pain. The clinical data were recorded, including gender, age, duration of symptoms, diagnosis type, medical co-morbidity, operation level, blood loss, operation time, pre- and post- JOA score, JOA recovery rate, and other complications. The radiograhic data including cervical canal diameter, C2-7 Cobb angle, cervical range of motion(ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed were measured in X-ray and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed. Results: There were 63 patients suffered from axial pain. Both groups gained significant JOA improvement after surgery(P<0.05). The preoperative neck pain, postoperative cervical alignment type, change of cervical curvature, cervical instability, negative change of cervical ROM and facet joints destroyed were included in multivariate analysis. There was no significant difference of other clinical and radiographic parameters between the groups(P>0.05). The multivariate analysis showed that the negative change of cervical ROM(P=0.047) and facet joints destroyed(P=0.041) were related to axial pain. Conclusions: The decrease of cervical ROM and facet joints destroyed by mini-screws may be risk factors of axial pain after cervical laminoplasty with mini-plate fixation. Cervical spine surgeons should carefully operate to decrease the injury of posterior musculature structure and protect the facet joints.