后纵韧带骨化症患者术前颈椎矢状位参数对术后疗效的影响

Relationship between cervical sagittal balance parameters and the clinical outcome after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  颈椎矢状面平衡参数  颈椎矢状面轴向距离  单开门椎管扩大成形术

英文关键词:Ossification of posterior longitudinal ligament(OPLL)  Cervical sagittal balance parameter  Sagittal vertical axis(SVA)  Open-door laminoplasty

中文摘要:

  【摘要】 目的：分析后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）患者术前颈椎矢状位参数对行单开门椎管扩大成形术患者术后疗效的影响。方法：回顾性分析2015年1月～2017年12月间，于我院诊断为OPLL并行颈后路单开门椎管扩大成形术的患者共181例。统计患者年龄、性别、手术节段、术前及术后1年随访时日本骨科协会（Japanese Orthopedic Association，JOA）评分，术前颈椎正侧位X线片测量颈椎矢状面参数包括C2-C7矢状面轴向距离（sagittal vertical axis，SVA）、头部重心（center gravity of head，CGH）-C7 SVA（CGH-C7 SVA）、C1-C7 SVA、T1倾斜角（T1 slope）。根据患者术后1年时JOA评分改善率采用四分法将改善最高的25%患者作为改善良好组，并将改善最差的25%患者作为改善较差组，使用单因素ANOVA和Logistic回归分析影响预后的矢状位参数指标。结果：OPLL患者术前C1-C7 SVA平均为22.5±9.6mm，C2-C7 SVA平均为25.2±12.5mm，CGH-C7 SVA平均为28.9±17.6mm，术前T1 slope平均为27.3°±9.6°，术前C2-7 Cobb角平均为11.8°±9.4°，平均术前JOA评分为8.7±2.5分。根据术后1年随访时JOA评分改善率进行分组后的术前颈椎矢状位参数分析，结果显示术前C1-C7 SVA、术前T1倾斜角以及术前CGH-C7 SVA（分别为P=0.048、P=0.027、P<0.01）与术后疗效密切相关。利用Logistic回归分析上述相关性指标后发现，仅术前CGH-C7 SVA（OR=1.654，P<0.01）为影响术后疗效的危险因素。结论：术前CGH-C7 SVA水平与行颈椎后路单开门椎管扩大成形术的OPLL患者最终疗效密切相关，术前CGH-C7 SVA大的患者术后疗效较差。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between preoperative cervical sagittal balance parameters with postoperative clinical outcome in ossification of posterior longitudinal ligament(OPLL) patients. Methods: Between January 2015 and December 2017, 181 consecutive patients who underwent cervical laminoplasty for OPLL were enrolled. Cervical spine CT, MRI and radiographs were taken before surgery, 2-month after surgery and at 1-year follow-up. The C2-C7 Cobb angle, C2-C7 sagittal vertical axis(SVA), center gravity of head(CGH)-C7 SVA, C1-C7 SVA, T1 slope and the Japanese Orthopedic Association(JOA) scores were also recorded. The patients were divided according to the JOA recovery rate at 1-year followup according to the quantile method. The relationships between postoperative and preoperative variables, including age, JOA score, C2-C7 Cobb angle, T1 slope, CGH-C7 SVA, C1-C7 SVA and C2-C7 SVA were investigated. Results: Mean preoperative of C1-C7 SVA, C2-C7 SVA, CGH-C7 SVA, T1 slope, C2-7 Cobb angle and JOA was 22.5±9.6mm, 25.2±12.5mm, 28.9±17.6mm, 27.3°±9.6°, 11.8°±9.4°, 8.7±2.5 respectively. Further analysis showed that preoperative C1-C7 SVA, T1 slope and CGH-C7 SVA were significantly correlated to the clinical outcome of OPLL patients at 1 year follow-up(P=0.048, P=0.027, P<0.01 respectively). Logistic regression analysis revealed only CGH-C7 SVA had a strong relationship with postoperative clinical outcome(OR=1.654, P<0.01). Conclusions: CGH-C7 SVA is a good predictor of postoperative clinical outcome of the cervical OPLL, and higher preoperative CGH-C7 SVA may increase the risk of bad clinical outcomes in laminoplasty treated OPLL patients.