单节段Prestige LP人工颈椎间盘置换术后高等级异位骨化的危险因素

Risk factors for high-grade heterotopic ossification after single-level cervical disc replacement with Prestige LP disc

中文关键词:  人工颈椎间盘置换术  异位骨化  危险因素  矢状面序列

英文关键词:Cervical disc replacement  Heterotopic ossification  Risk factor  Sagittal alignment

中文摘要:

  【摘要】 目的：研究单节段Prestige LP人工颈椎间盘置换术后发生高等级异位骨化的危险因素。方法：回顾性分析我院2008年2月～2016年12月行单节段Prestige LP颈椎间盘置换术的患者61例，其中男性24例，女性37例，年龄43.6±7.8岁，随访时间50.0±22.6个月。所有患者于术前和末次随访时收集临床资料[日本骨科学会（JOA）评分、视觉模拟评分（VAS）]，并于术前、术后3天、术后3个月、术后12个月及末次随访时收集颈椎矢状面序列参数（C2~C7整体曲度、手术节段曲度、假体开口角度、C2~C7矢状面轴向垂线）、手术节段椎间高度指数、C2~C7活动度、假体活动度。末次随访时根据McAfee分级法将患者分为高等级异位骨化组（A组，包括McAfee Ⅲ-Ⅳ）和无高等级异位骨化组（B组，包括无异位骨化、McAfee Ⅰ-Ⅱ级）。通过独立样本t检验或χ2检验分析两组间的差异；采用秩和检验进行分析假体大小对结果的影响；采用二元逻辑回归方法分析高等级异位骨化的危险因素。结果：两组患者术后临床疗效均明显改善，两组间对比无显著差异（P＞0.05）。假体大小对高等级异位骨化的发生无明显影响（P＞0.05）。A组患者平均随访时间为59.7±28.4个月，B组患者为47.6±20.6个月，差异无统计学意义（P=0.097）。在运动功能方面，患者术前颈椎整体活动度A组为47.3°±15.4°，B组为54.1°±15.1°，差异无统计学意义（P=0.168）；患者术前手术节段活动度A组为8.7°±4.7°，B组为11.1°±4.6°，差异无统计学意义（P=0.106）。在颈椎矢状面序列方面，患者术后3个月时C2～C7曲度A组为2.8°±9.4°，B组为10.9°±10.2°，差异有统计学意义（P=0.015）；患者术后3个月时C2～C7 SVA A组为21.7±8.8mm，B组为16.2±7.3mm，差异有统计学意义（P=0.029）。结论：术后早期颈椎矢状面序列不佳可能是单节段Prestige LP颈椎间盘置换术后高等级异位骨化发生的危险因素。

英文摘要:

  【Abstract】 Objectives: To evaluate the risk factors of high-grade heterotopic ossification(HO) after single-level cervical disc replacement with Prestige LP disc. Methods: 61 patients(24 males and 37 females) underwent single-level Prestige LP cervical disc replacement from February 2008 to December 2016 were retrospectively included in this study. The mean age was 43.6±7.8 (26-63) years old. The clinical data (such as Japanese Orthopedic Association score and visual analogue score) were collected before surgery and at the last follow-up. Radiological data including cervical sagittal alignment parameters (C2-C7 cervical lordosis, segmental lordosis, disc angle, and C2-C7 sagittal vertical axis), disc height index at the surgical level, C2-C7 range of motion, and segmental range of motion at the surgical level were collected before surgery and at 3-day, 3-month, 12-month and at the last follow-up after surgery. McAfee classification system was used to evaluate the grade of heterotopic ossification. Patients were divided into high-grade HO group (group A, McAfee grade Ⅲ-Ⅳ) and non high-grade HO group (group B without HO and McAfee gradeⅠ-Ⅱ). Student t-test and chi-square test were used to evaluate the difference between the two groups. Paired t-test was used to compare preoperative and post-operative clinical outcomes. Implant size was analyzed using the rank sum test. Univariate logistic regression analysis was used to assess the risk factors for high-grade HO. Results: The clinical results of both groups were significantly improved. There was no significant difference in the improvement of clinical results between the two groups. There was no obvious impact of the implant size on the development of high-grade HO. The mean follow-up time for gourp A and group B was 59.7±28.4m and 47.6±20.6m respectively, the difference was not statistically significant(P=0.097). For the motion function, the global range of motion before surgery for group A and group B was 47.3°±15.4° and 54.1°±15.1° respectively, but the difference was not statistically significant(P=0.168). The segmental range of motion at the surgical level before surgery for group A and group B was 8.7°±4.7° and 11.1°±4.6° respectively, but the difference was not statistically significant(P=0.106). For the cervical sagittal alignments, the C2-C7 cervical lordosis at the 3-month follow-up for group A and group B was 2.8°±9.4° and 10.9°±10.2° respectively, and there was significant difference between two groups(P=0.015). The C2-C7 SVA at the 3-month follow-up for group A and group B was 21.7±8.8mm and 16.2±7.3mm, and and there was significant difference between two groups(P=0.029). Conclusions: Poor cervical sagittal alignment in the early period after surgery could increase the risk of high-grade HO after single-level Prestige LP cervical disc replacement.