颈前路经椎间隙行钩椎关节松解治疗退变性颈椎后凸畸形的疗效分析

To evaluate the efficacy of anterior cervical trans-intervertebral decompression with segmental distraction and fusion in treating degenerative cervical kyphosis

中文关键词:  退变性颈椎后凸畸形  颈椎矢状位平衡参数  钩椎关节松解

英文关键词:Degenerative cervical kyphosis  Cervical sagittal balance  Uncovertebral joint resection

中文摘要:

  【摘要】 目的：探讨颈前路减压植骨融合内固定术中行钩椎关节松解治疗退变性颈椎后凸畸形的疗效。方法： 回顾性分析2017年1月~2019年1月在我院行颈前路减压植骨融合内固定术且在术中经椎间隙行钩椎关节松解治疗的41例退变性颈椎后凸畸形患者，其中男17例，女24例；年龄64.8±9.7岁。僵硬性后凸24例，非僵硬性后凸17例，对僵硬性颈椎后凸畸形患者行双侧钩椎关节切除松解。手术节段为2个节段的患者3例（C3~C4，1例；C4~C6，2例），3个节段患者28例（C3~C6，11例；C4~C7，17例），4个节段患者10例（C3~C7，10例）。术前及末次随访通过日本骨科学会（Japanese Orthopaedic Association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、颈痛及根性疼痛的视觉模拟评分法（visual analogue scale，VAS）评分评估患者神经功能变化。收集患者术前及末次随访时颈椎X线片，测量C2~C7 Cobb角、手术节段Cobb角及C2~C7矢状位轴向垂直距离（sagittal vertical axis，SVA）。采用配对样本t检验对手术前后神经功能及影像学资料进行统计分析，并统计患者术后并发症发生情况。结果：所有患者手术顺利，手术时间124~210min（162.5±28.6min），术中出血量70~200ml（121.1±34.2ml），随访时间35.5±7.7个月（24~48个月）。所有患者术后神经功能均得到明显改善，术前JOA评分10.7±2.4分，末次随访15.6±1.3分，差异有统计学意义（P＜0.05），改善率（75.5±27.4）%（0~100%）；术前NDI为24.4±7.9分，末次随访8.7±3.9分，差异有统计学意义（P＜0.05），改善率（65.7±21.4）%（30%~100%）；术前VAS评分4.3±1.9分，末次随访1.9±1.3分，差异有统计学意义（P＜0.05）。患者颈椎矢状面参数明显改善，术前颈椎整体Cobb角（C2~C7）为-16.5°±5.3°，末次随访10.2°±5.1°（P＜0.05）；SVA由术前33.2±13.7mm改善至末次随访时17.5±7.8mm（P＜0.05）；手术节段Cobb角术前为-19.8°±5.7°，末次随访为11.3°±2.2°（P＜0.05）。围手术期并发症4例，颈部血肿1例，声音嘶哑1例，轻度吞咽困难2例，患者经保守治疗后症状缓解；18例患者在末次随访时出现邻近节段退变的影像学表现。结论：采用颈前路减压植骨融合内固定术并在术中经椎间隙行钩椎关节松解治疗退变性颈椎后凸畸形可以获得满意的临床效果，重建颈椎曲度及颈椎矢状位平衡。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy uncinate process resection combined with anterior cervical discectomy and fusion(ACDF) in the treatment of degenerative cervical kyphosis. Methods: This study retrospectively reviewed a total of 41 cases of degenerative cervical kyphosis(24 cases with rigid kyphosis and 17 cases with flexible kyphosis) ACDF and uncovertebral joint reduction. There were 17 males and 24 females，there were 3 patients with 2 surgical segments, 28 patients with 3surgical segments and 10 patients with 4 surgical segments. The neurological functions of the patients were evaluated by the Japanese Orthopaedic Association(JOA) score, neck disability index(NDI), and visual analogue scale(VAS) score before and at the final follow-up respectively. X-ray images before and at the final follow-up were collected, and the C2-C7 Cobb angle, the surgical segment Cobb angle, and the C2-C7 sagittal vertical axis(C2-C7 SVA) were measured. A paired-sample t-test was used for statistical analysis before and after the surgery. Results: The average operative time was 124-210min(162.5±28.6min), the blood loss was 70-200ml(121.1±34.2ml), and the follow-up period was 35.5±7.7months(23-48months). The neurological functions of all the patients were significantly improved after surgery. The JOA score was 10.7±2.4 before operation, and it was 15.6±1.3 at the final follow-up(P<0.05) with an average improvement rate of (75.5±27.4)%(0-100%). The NDI at the final follow-up was 8.7±3.9 points, which was improved (65.7±21.4)%(30-100%) from 24.4±7.9 preoperatively(P<0.05). The VAS score was 4.3±1.9 before operation, and it was 1.9±1.3 at the final follow-up, which significantly improved(P<0.05). The sagittal parameters of the cervical spine were significantly improved. The overall Cobb angle (C2-C7) was -16.5°±5.3° before surgery and 10.2°±5.1° at the final follow-up(P<0.05). SVA improved from 33.2±13.7mm preoperatively to 17.5±7.8mm at the final follow-up(P<0.05). The surgical segment cobb angle was significantly improved from preoperative -19.8°±5.7° to 11.3°±2.2° at the last follow-up(P<0.05). Perioperative complications occurred in 4 cases, which included postoperative hematoma in 1 case, hoarseness in 1 case, and mild dysphagia in 2 cases. The symptoms were all relieved after conservative treatments. Another 18 patients had imaging manifestations of adjacent segment degeneration at the final follow-up. Conclusions: The use of uncovertebral joint reduction via ACDF in the treatment of degenerative cervical kyphosis can achieve satisfactory clinical results, and it can significantly reconstruct cervical spine curvature and cervical spine sagittal balance.