下颈椎前路减压融合术后颈椎矢状位平衡的变化

Changes of cervical sagittal balance after anteriorcervical discectomy and fusion

中文关键词:  颈椎病  颈椎前路减压融合术  融合节段  矢状位平衡

英文关键词:Cervical spondylosis  Anterior cervical discectomy and fusion  Fusion segments  Sagittal balance

中文摘要:

  【摘要】 目的：探讨下颈椎前路减压融合术后颈椎矢状位平衡的变化。方法：回顾性分析2012年1月～2016年12月在上海市东方医院脊柱外科因颈椎病接受颈前路椎间盘切除减压椎间融合手术（ACDF）患者的资料，共纳入326例，其中男175例，女151例；年龄34～81岁（56.0±9.4岁）。随访12～30个月（18.5±6.4个月），根据融合节段数分为四组：单节段融合组69例，双节段融合组85例，三节段融合组90例，四节段融合组82例。在术前及术后12个月随访时的颈椎侧位X线片上测量颈椎矢状位参数：C0-2 Cobb角、C2-7 Cobb角、C2-7矢状垂直距离（C2-7 SVA）和T1倾斜角（T1S），并记录手术前后JOA评分及颈肩臂疼痛VAS评分，计算术后12个月时各组参数改变量。单因素方差分析比较参数及评分指标改变量组间差异，Pearson相关性探讨术前及术后12个月颈椎矢状位参数变化关系。结果：四组患者一般资料无统计学差异（P>0.05）。术前和ACDF术后12个月，单节段融合组C0-2 Cobb角为21.07°±8.21°和20.92°±5.99°，C2-7 Cobb角为15.29°±8.64°和17.69°±11.25°，C2-7 SVA为20.94±10.77mm和20.61±10.23mm，T1S为23.02°±8.64°和24.05°±9.35°，术前与术后比较均无统计学差异（P>0.05）；双节段融合组C0-2 Cobb角为20.38°±7.49°和24.20°±7.96°，C2-7 Cobb角为13.04°±8.07°和15.85°±10.53°，C2-7 SVA为18.57±11.88mm和23.73±9.87mm，T1S为24.28°±6.71°和28.65°±7.64°，术前与术后比较均有统计学差异（P<0.05）；三节段融合组C0-2 Cobb角为16.76°±6.24°和20.54°±6.58°，C2-7 Cobb角为11.46°±7.83°和15.12°±10.42°，C2-7 SVA为19.36±8.40mm和25.25±12.20mm，T1S为26.56°±9.47°和30.39°±7.31°，术前与术后比较均有统计学差异（P<0.05）；四节段融合组C0-2 Cobb角为15.44°±6.50°和18.39±6.26°，C2-7 Cobb角为11.54°±8.30°和19.61°±5.53°，C2-7 SVA为22.39±12.60mm和27.68±11.17mm，T1S为24.70°±6.30°和31.22°±6.45°，术前与术后比较均有统计学差异（P<0.05）。术前和术后12个月，四组组内T1S与C2-7 Cobb角、C2-7 SVA均呈正相关，C2-7 Cobb角与C2-7 SVA均呈负相关；术后12个月，四组间C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA及T1S改变量比较差异均有统计学意义（P=0.010、0.001、0.003、0.002）。结论：下颈椎前路减压单节段融合后颈椎矢状位平衡无明显变化；双节段及长节段融合后颈椎矢状位平衡显著改变，但下颈椎矢状位序列维持动态稳定。

英文摘要:

  【Abstract】 Objectives: To explore the changes of cervical sagittal balance after anterior cervical discectomy and fusion. Methods: A total of 326 patients with lower cervical spondylosis, who underwent anterior cervical discectomy and fusion in spinal surgery department of Shanghai East Hospital from January 2012 to December 2016 were reviewed, including 175 males and 151 females, and aging from 34 to 81 years old(average, 56.0± 9.4 years old). The follow-up time was 12 to 30 months, with an average of 18.5±6.4 months. According to the fusion segment, patients were divided into four groups: 69 cases in single segment fusion group, 85 cases in double segments fusion group, 90 cases in three segments fusion group, 82 cases in four segments fusion group. Radiographic parameters on cervical spine X-ray, clinical scores before surgery and at 12 months after surgery were recorded: occiput-C2 angle(C0-2 Cobb), C2-7 Cobb, C2-7 sagittal vertical axis(C2-7 SVA) and T1 slope(T1S), Japanese Orthopaedic Association(JOA) and visual analog scale(VAS) scores. The changes of sagittal parameters and scores from preoperation to 12 months after surgery were calculated and compared among the four groups by using one-way-ANOVA. Pearson analysis was employed to explore the correlation of sagittal parameters before surgery and 12 months after surgery. Results: There was no significant difference of general data among the four groups. From preoperation to 12 months after surgery in single segment fusion group, C0-2 Cobb decreased from 21.07°±8.21° to 20.92°±5.99°(P=0.888), C2-7 Cobb increased from 15.29°±8.64° to 17.69°±11.25°(P=0.125), C2-7 SVA decreased from 20.94±10.77mm to 20.61±10.23mm(P=0.839), T1S increased from 23.02°±8.64° to 24.05°±9.35°(P=0.450); in two segments fusion group, C0-2 Cobb increased from 20.38°±7.49° to 24.20°±7.96°(P=0.000), C2-7 Cobb increased from 13.04°±8.07° to 15.85°±10.53°(P=0.003), C2-7 SVA increased from 18.57±11.88mm to 23.73±9.87mm(P=0.000), T1S increased from 24.28°±6.71° to 28.65°±7.64°(P=0.000); in three segments fusion group, C0-2 Cobb increased from 16.76°±6.24° to 20.54°±6.58°(P=0.000), C2-7 Cobb increased from 11.46°±7.83° to 15.12°±10.42°(P=0.001), C2-7 SVA increased from 19.36±8.40mm to 25.25±12.20mm(P=0.000), T1S increased from 26.56°±9.47° to 30.39°±7.31°(P=0.000); in four segments fusion group, C0-2 Cobb increased from 15.44°±6.50° to 18.39°±6.26°(P=0.000), C2-7 Cobb increased from 11.54°±8.30° to 19.61°±5.53°(P=0.001), C2-7 SVA increased from 22.39±12.60mm to 27.68±11.17mm(P=0.000), T1S increased from 24.70°±6.30° to 31.22°±6.45°(P=0.000). T1S had positive relationship with C2-7 Cobb and C2-7 SVA, C2-7 Cobb had negative relationship with C2-7 SVA in each group before and 12 months after operation. The changes of C0-2 Cobb, C2-7 Cobb, C2-7 SVA and T1S had significant differences among the four groups(P=0.000, 0.013, 0.001, 0.000). Conclusions: The cervical sagittal balance changed with no significant difference after single-segment ACDF, two- and long-segments ACDF changed cervical sagittal balance significantly, but lower cervical sagittal alignment maintained dynamic stability.