改良椎板成形术治疗颈椎后纵韧带骨化症术后颈椎矢状位参数变化与临床疗效关系

Relationship between sagittal parameters and clinical efficacy of modified laminoplasty in the treatment of ossification of the posterior longitudinal ligament of cervical spine

中文关键词:  颈椎后纵韧带骨化症  椎板成形术  C3椎板切除  矢状位序列

英文关键词:Ossification of the posterior longitudinal ligament  Laminoplasty  C3 laminectomy  Sagittal alignment

中文摘要:

  【摘要】 目的：探讨C3椎板切除、C7椎板U形切除的改良椎板成形术治疗颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament，OPLL）术后颈椎矢状位参数变化及其对临床疗效的影响。方法：采用病例对照研究的方法，纳入99例OPLL患者。其中C3切除组42例，男22例，女20例，平均年龄61.4±9.23岁（39～78岁），采用C3椎板切除、C4-6椎板单开门、C7椎板U型切除。同期采用标准单开门椎管扩大成形术（C3开门组）患者57例，男31 例，女26例，平均年龄59.3±8.65岁（41～79岁）。平均随访45.9±8.8个月，观察两组患者术前术后JOA、NDI评分，观察两组患者术前后颈椎生理曲度及C2-7 SVA值变化。对各组内颈椎是否保持前凸的患者分成亚组，对比亚组间JOA及NDI评分差异。对比C3开门组内行C3-6及C3-7开门的患者的矢状位参数变化值。结果：两组患者术前各项指标无统计学差异，至末次随访时两组患者的JOA及NDI评分均显著好转，末次随访JOA评分两组间无差异，而C3切除组的NDI（6.06±4.49）优于C3开门组（8.25±7.53）。末次随访时两组颈椎曲度均有不同程度的降低，C3切除组颈椎曲度对比术前无统计学差异（颈椎曲度变化值为3.30°±9.36°），而C3开门组有差异（颈椎曲度变化值为6.25°±10.22°），两组间颈椎曲度值及变化值均有统计学差异（P＜0.05）。末次随访两组的C2-7 SVA均有不同程度的增加，对比术前SVA，C3切除组无统计学差异，而C3开门组有差异，两组间的C2-7 SVA值及变化值有统计学差异（P＜0.05）。C3开门组患者中有30例行C3-6开门，27例行C3-7开门，两亚组患者的术前及末次随访的颈椎生理曲度及C2-7 SVA值均无统计学差异。末次随访时两组内颈椎前凸及后凸的病例的JOA, NDI评分变化，神经功能改善率均无统计学差异（P＞0.05）。结论：C3椎板切除的改良椎板单开门成形术能有效维持术后颈椎生理曲度，在一定程度上减缓颈椎后路术后颈椎后凸畸形的进展。手术后颈椎矢状面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 investigate the effect of modified laminoplasty with C3 laminectomy and C7 U type laminectomy in maintaining the sagittal balance of cervical spine and its effect on the clinical outcome. Methods: 99 cases with ossification of the posterior longitudinal ligament(OPLL) were included in a case-control study. There were 42 patients in C3 laminectomy group, included 22 males and 20 females, with an average age of 61.4±9.2 years(39-78 years). C3 laminectomy, C4-6 laminectomy and C7 laminectomy were performed. At the same time, 57 patients (31 males and 26 females, mean age 59.3±8.65 years, 41-79 years) were treated with standard laminoplasty (C3 open group). The mean follow-up was 45.9±8.8 months. The JOA and NDI scores of the two groups were observed pre- and post- operation. The changes of cervical physiological curvature and C2-7 SVA pre-and post-operation were observed in the two groups. The patients with cervical spondylosis in each group were divided into subgroups, and the differences of JOA and NDI scores between the subgroups were compared. Comparison of sagittal parameters between C3-6 and C3-7 laminoplasty in C3 open group were performed. Results: There was no significant difference in preoperative indexes between the two groups, and the JOA and NDI scores of the two groups were significantly improved at final follow-up. There was no difference in JOA score between the two groups at final follow-up, but the NDI scores in C3 laminectomy group was better(6.06±4.49 vs 8.25±7.53). At final follow-up, the cervical curve of the two groups decreased in varying degrees. Compared with the preoperative cervical curve, there was no significant difference in C3 laminectomy(the variation of cervical curvature was 6.25°±10.22°), but there was difference in the C3 laminoplasty group(the variation of cervical curvature was 6.25°±10.22°). There were significant differences in cervical curve between the two groups(P＜0.05). At final follow-up, the C2-7 SVA of the two groups increased in varying degrees, there was no significant difference in C3 laminectomy group compared with the preoperation, but there was significant difference in C3 laminoplasty group, and there was significant difference in C2-7 SVA between the two groups. There were 30 cases of C3-6 laminoplasty and 27 cases of C3-7 laminoplasty, and there was no significant difference in cervical curve and C2-7 SVA between the two subgroups. There was no significant difference in JOA, NDI scores between cervical lordosis and kyphosis groups at final follow-up(P＞0.05). Conclusions: The modified laminoplasty with C3 laminectomy can effectively maintain the postoperative cervical curve and slow down the progress of cervical kyphosis after posterior cervical surgery. There was no significant correlation between the changes of cervical sagittal participation and the clinical effect post-operation.