| 郭山强,王帅,盖利,等.颈椎前路椎间盘切除融合术后颈椎矢状位参数变化及其对临床疗效的影响.骨科,2019,10(1): 8-13. |
| 颈椎前路椎间盘切除融合术后颈椎矢状位参数变化及其对临床疗效的影响 |
| Changes of sagittal parameters of cervical spine after anterior cervical discectomy and fusion and its effects on clinical efficacy |
| 投稿时间：2018-05-15 |
| DOI：10.3969/j.issn.1674-8573.2019.01.002 |
| 中文关键词: 颈前路椎间盘切除融合术 颈椎矢状位参数 矢状序列 临床疗效 |
| 英文关键词: Anterior cervical discectomy and fusion Sagittal parameters of cervical spine Sagittal sequence Clinical efficacy |
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| 中文摘要: |
| 目的 探讨颈椎间盘突出症病人行颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion, ACDF）后颈椎矢状位参数变化及其对临床疗效的影响。方法 选取2014年1月至2016年1月在我院接受ACDF手术治疗的颈椎间盘突出症病人98例，对其临床资料进行回顾性分析。其中，男50例，女48例；年龄为（54.75±8.60）岁（40~78岁）。收集比较98例病人术前及随访时的C2~7 Cobb角、T1倾斜角、C2~7矢状面轴向距离（cSVA）、颈倾角（NTA）、胸廓入口角（TIA）等矢状位参数，以及其手术前后的颈肩臂疼痛视觉模拟量表（visual analogue scale, VAS）评分、日本骨科学会（Japanese Orthopaedic Association, JOA）评估治疗分数、颈椎功能障碍指数（neck disability index, NDI）。98例病人根据T1倾斜角是否大于30°分为高T1倾斜角组和低T1倾斜角组，比较两组病人的JOA评分改善率及后凸畸形发生率。结果 本研究所观察的矢状位参数中，术后T1倾斜角、C2~7 Cobb角较术前显著增大，NTA、cSVA较术前显著减小；功能相关指标中，VAS评分较术前显著下降，JOA评分显著上升，与术前比较，差异均有统计学意义（P均＜0.05）。高T1倾斜角组和低T1倾斜角组的JOA治疗改善率（56.06% vs. 53.12%）及后凸畸形发生率（12.50% vs. 16.67%）比较，差异均有统计学意义（χ2=12.538，P=0.001；χ2=10.895，P=0.003）。且高T1倾斜角组病人中，单节段、双节段、多节段病人的后凸畸形发生率均显著低于低T1倾斜角组，差异均有统计学意义（P均＜0.05）。结论 ACDF治疗颈椎间盘突出症的短期临床疗效确切，T1倾斜角＞30°病人的JOA治疗改善率较高，后凸畸形发生率较低。 |
| 英文摘要: |
| Objective To investigate the changes of sagittal parameters of cervical spine after anterior cervical discectomy and fusion (ACDF) in patients with cervical disc herniation and its effect on clinical efficacy. Methods Ninety-eight patients with cervical disc herniation treated by ACDF from January 2014 to January 2016 in our hospital were selected and their clinical data were analyzed retrospectively. Among them, there were 50 males and 48 females with age of (54.75±8.60) years old (40-78 years). Sagittal parameters such as C2-7 Cobb angle, T1 tilt angle, C2-7 sagittal axial distance (cSVA), neck tilt angle (NTA), thoracic entrance angle (TIA) and visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) were collected and compared in 98 patients before and after surgery. Ninety-eight patients were divided into high T1 tilt angle group and low T1 tilt angle group according to whether the T1 tilt angle was greater than 30°. The improvement rate of JOA score and the incidence of kyphosis were compared between the two groups. Results Among the sagittal parameters observed in this study, T1 tilt angle and C2-7 Cobb angle increased significantly after surgery, while NTA and cSVA decreased significantly after surgery. Among the function-related indicators, VAS score decreased significantly and JOA score increased significantly after treatment as compared with those before operation (P＜0.05 for all). The improvement rate of JOA score (56.06% vs. 53.12%) and the incidence of kyphosis deformity (12.50% vs. 16.67%) in high T1 tilt angle group and low T1 tilt angle group were significantly different (χ2=12.538, P=0.001; χ2=10.895, P=0.003). In high T1 tilt angle group, incidence of kyphosis in patients with single, double and multiple segments was significantly lower than that in low T1 tilt angle group (P＜0.05 for all). Conclusion The short-term clinical efficacy of ACDF in the treatment of cervical disc herniation is definite, and the improvement rate of JOA score in patients with T1 tilt angle ＞30° is more obvious, with lower kyphosis incidence. |
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