| 解放,凃志鹏,龚克,等.零切迹椎间融合器行单节段颈前路减压融合术后T1倾斜角与融合器沉降的关系研究.骨科,2018,9(3): 206-211. |
| 零切迹椎间融合器行单节段颈前路减压融合术后T1倾斜角与融合器沉降的关系研究 |
| The relationship between the degree of the T1 Slope and the incidence of cage subsidence following one-level ACDF with Zero-P |
| 投稿时间：2018-03-15 |
| DOI：10.3969/j.issn.1674-8573.2018.03.009 |
| 中文关键词: 颈前路减压 脊柱融合术 Zero-P椎间融合器 T1倾斜角 融合器沉降 影响因素分析 |
| 英文关键词: Anterior decompression Spinal fusion Zero-P T1 Slope Cage subsidence Root cause analysis |
| 基金项目:国家自然科学基金（81371947） |
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| 中文摘要: |
| 目的 研究零切迹椎间融合器（Zero-Profile interbody fusion device, Zero-P）行单节段颈前路减压融合术（anterior cervical decompression and fusion, ACDF）后，胸1倾斜角（T1 Slope, T1S）与融合器沉降发生的关系。方法 回顾性分析2011年5月至2015年8月我院采用Zero-P置入治疗的49例颈椎间盘突出症病人的临床资料，其中男25例，女24例，年龄为33~68岁，平均（45.86±7.95）岁。在病人手术前后的颈椎侧位X线片上测量颈椎前凸角（cervical lordosis, CL）、T1S、手术节段前凸角（segmental angle, SA）、颈椎矢状位垂直轴（cervical sagittal vertical axis, cSVA）、手术节段高度（segmental height, SH）；采用疼痛视觉模拟量表（visual analogue scale, VAS）、颈椎功能障碍指数（neck disability index, NDI）评价临床效果。采用统计学分析各矢状位参数与临床疗效的关系以及融合器发生沉降的危险因素。结果 本组随访24~75个月，平均48.3个月。术后及末次随访的T1S、SA角度大小与VAS评分呈负相关，T1S、SA、CL角度大小与NDI呈负相关。融合器沉降的发生与术后NDI呈负相关。发生融合器沉降与未发生沉降病例的CL、T1S、SA值比较，差异均有统计学意义（P均＜0.05）。纳入多因素Logistic回归分析后发现，术前T1S大小是融合器沉降发生的独立危险因素。应用ROC分析截断值为18°（曲线下面积=0.787，敏感度=0.737，特异度=0.733，P=0.004），术前T1S≤18°的病人的融合器沉降率是T1S＞18°的病人的7.7倍（P=0.001）。结论 应用Zero-P系统行单节段ACDF，术前T1S≤18°的病人术后发生融合器沉降的风险较高。 |
| 英文摘要: |
| Objective To determine the relationship between the degree of the T1 slope (T1S) and the incidence of cage subsidence following one-level ACDF with Zero-P. Methods We retrospectively analyzed 49 patients (male∶female, 25∶24; mean age, 45.86±7.95 years old) who underwent one-level ACDF with Zero-P from May 2011 to August 2015. Parameters including cervical lordosis (CL), T1S, cervical sagittal vertical axis (cSVA), segmental angle (SA), and segmental height (SH) on plane radiographs were measured. VAS and NDI were used to analyze clinical outcomes. Risk factors of subsidence were determined using multivariate logistic regression. Results The mean clinical follow-up was 48.3 months (range 24-75 months). The angles of T1S, SA and CL were correlated with clinical outcomes. The occurrence of subsidence was negatively correlated with outcomes. There were significant differences in pre-operative angles of CL, T1S and SA between subsidence and non-subsidence group. Multivariate logistic regression analysis revealed that there was a strong correlation between pre-operative T1S and cage subsidence. A cutoff value of T1S ≤18° significantly predicted subsidence (sensitivity: 73.7%; specificity: 73.3%, P=0.004) and lower T1S was associated with higher risk of subsidence (LR=7.7, P=0.001). Conclusion A lower T1S (T1S ≤18°) could be a risk factor of subsidence following one-level ACDF with Zero-P. |
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