| 李国,吴建峰,黄稳定.单节段椎间盘切除联合ROI-C植入术后颈椎弧度改变对疗效的影响.骨科,2018,9(2): 96-101. |
| 单节段椎间盘切除联合ROI-C植入术后颈椎弧度改变对疗效的影响 |
| Effect of global cervical alignment change on the clinical outcome after single-level anterior cervical discectomy and fusion with ROI-C |
| 投稿时间：2017-10-22 |
| DOI：10.3969/j.issn.1674-8573.2018.02.003 |
| 中文关键词: 颈椎 减压术，外科 脊柱融合术 颈椎弧度 治疗效果 |
| 英文关键词: Cervical vertebrae Decompression, surgical Spinal fusion Global cervical alignment Treatment outcome |
| 基金项目:上海市虹口区卫生和计划生育委员会医学科研课题（1704-33） |
|
| 摘要点击次数: 6312 |
| 全文下载次数: 0 |
| 中文摘要: |
| 目的 分析颈前路采用零切迹颈椎融合器（ROI-C）行单节段椎间盘切除减压融合术（anterior cervical discectomy and fusion, ACDF）术后颈椎整体弧度（global cervical alignment, GCA）改变对疗效的影响。方法 回顾性分析我院于2012年1月至2014年5月使用ROI-C行单节段ACDF治疗颈椎间盘退变性疾病病人82例，其中男48例，女34例，年龄为35~81岁，平均55.3岁。末次随访的颈椎侧位X线片与术前比较：①维持组，GCA手术前后均为前凸者；②矫正组，术前GCA后凸、术后矫正为前凸者；③后凸组，手术前后均后凸者。记录术前和末次随访的颈部、手臂疼痛视觉模拟量表（neck/arm pain visual anologue scales, NVAS/AVAS）评分和颈部功能障碍指数（neck disability index, NDI）。结果 2012年3月至2016年12月对病人进行术后随访，随访时间为21~39个月，平均25.6个月。维持组46例，矫正组17例，后凸组19例，三组病例年龄分布存在差异（F组间=4.593，P=0.014）；三组病人性别和手术节段之间比较，差异均无统计学意义（均P＞0.05）。术后GCA后凸发生率为23.17%（19/82）。术前三组间NVAS、AVAS和NDI各指标单变量方差分析，差异均无统计学意义（均P＞0.05）。三组末次随访的NVAS、AVAS和NDI与各组术前比较，差异均具有统计学意义（均P＜0.05）。三组之间AVAS术后改善情况比较，差异没有统计学意义（F组间=0.580，P=0.562）；而改善程度△NVAS和△NDI的比较，差异均有统计学意义（均P＜0.05）。使用Dunnett-t检验行两两比较显示，矫正组的改善程度△NVAS和△NDI优于维持组和后凸组，差异均有统计学意义（均P＜0.05）。结论 采用ROI-C行单节段ACDF治疗颈椎退变性疾病，颈椎弧度由术前后凸矫正为前凸可获更多的NVAS和NDI改善，说明恢复和维持生理性前凸的GCA是取得最优疗效的重要因素；但术前存在GCA后凸的部分病例术后仍有颈椎后凸的影像学表现，因此治疗伴有GCA后凸的病例时，术者应谨慎确定融合固定的方式。 |
| 英文摘要: |
| Objective To evaluate and analyze the effect of maintaining or restoring global cervical alignment (GCA) on single-level anterior cervical discectomy and fusion with standalone ROI-C in the patients with degenerative disc diseases. Methods Data were collected from 82 patients who underwent single-level ACDF with ROI-C between January 2012 and May 2014. GCA was measured preoperatively and at last follow-up visit according to C2-7 Cobb angle. The patients were classified into three groups based on the last follow-up change of their GCA: maintained (M) group including patients with preoperative lordotic cervical alignment maintained postoperatively; restored (R) group with preoperative cervical kyphosis restored to lordosis postoperatively; and kyphotic (K) group with preoperative cervical kyphosis not changed into lordosis postoperatively. Visual analog scale for neck pain and arm pain (NVAS and AVAS), and Neck Disability Index (NDI) scores were obtained preoperatively and at the last follow-up visit. The postoperative improvement was represented with the differences between preoperative and last follow-up parameters (△NVAS, △AVAS and △NDI). Results All patients were followed up for 25.6 months on average. There were 46 patients in the K group, 17 patients in the R group and 19 patients in the K group. The incidence of cervical unchanged kyphotic alignment was 23.17% after single-level ACDF. The patients were younger in the K group (50.88±10.42 years old) than in the M group (58.54±10.14 years old, P=0.013) and in the R group (59.53±9.62 years old, P=0.024) by Dunnett-t test. Preoperatively, NVAS, AVAS and NDI scores were not statistically different among the three groups (P＞0.05). NVAS, AVAS and NDI scores were improved statistically in all three groups at last follow-up (P＜0.05). There was no significant difference in the △AVAS scores among the three groups by one-way ANOVA (P=0.562), whereas there was significant difference in the △NVAS and △NDI scores (P＜0.05). Subsequently, △NVAS and △NDI scores were greater in the R group than in the M group and in the K group by Dunnett-t test (P＜0.05). Conclusion The patients with restored and maintained lordotic GCA had significantly greater NVAS and NDI improvement treated by single-level ACDF with ROI-C. Our study suggests that restoration and maintenance of lordotic GCA will contribute to optimal clinical outcome. It is worth noting that some cases with preoperative cervical kyphosis remained kyphotic in the radiological appearance at follow-up. Caution is recommended when ROI-C is decided to be used in patients with cervical kyphosis. |
|
查看全文
下载PDF阅读器 |
| 关闭 |
