CAJ | 학술논문

目的探索颈后路椎管扩大椎板成形术后颈椎矢状位平衡变化.方法 2008年1月至2011年7月北京大学第三医院骨科对90例因脊髓型颈椎病接受C3-C7颈后路单开门椎管扩大椎板成形术患者的临床和影像学资料进行回顾性分析.统计日本骨科协会颈髓功能评分(JOA)及改善率.比较术前及末次随访时X线侧位片上C2椎体矢状面垂直轴线至C7椎体后上缘的距离(SVA);颅底连线与C2椎体下缘连线的交角(Cobb角);T1椎体上缘连线与水平线的交角(T1-Slope),三者分别反映颈椎前倾程度、上颈椎前凸程度以及颈胸段后凸程度.结果随访平均16.7(3 ～40)个月.JOA评分由术前(12.2±0.3)分增至术后(14.6±0.2)分,改善率为43.5％±4.2％.C2-C7 SVA、C0-2 Cobb角、T1-Slope各项术后与术前相比差异均有统计学意义(P=0.022,P＜0.001,P=0.002).C2-C7 SVA从术前(20.7 ±1.1)mm增加到(23.0±1.2) mm;C0-2 Cobb角从术前(19.9±0.8)°增加到(23.1±0.8)°;T1-Slope从术前(25.1±0.7)°增加到(26.2±0.7)°.C0-2 Cobb角变化以及T1-Slope变化分别与C2-C7 SVA的变化呈正相关(Pearson=0.469,P＜0.001)、(Pearson=0.303,P=0.004).术后C2-C7 SVA、C0-2 Cobb角、T1-Slopes的变化与轴性疼痛程度均无显著相关性(P=0.838,P=0.554,P=0.629).与术前T1-Slope较低的患者相比,术前T1-Slope较高的患者手术后JOA改善率较低(31.5％比53.7％,P=0.019).结论颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡出现显著变化,表现为颈椎向前倾斜,机体只能通过上颈椎肌肉持续强力收缩、保持上颈椎过度前凸来代偿.术前较高的T1-Slope将影响颈椎后路单开门手术的疗效.
목적 탐색경후로추관확대추판성형술후경추시상위평형변화.방법 2008년1월지2011년7월북경대학제삼의원골과대90례인척수형경추병접수C3-C7경후로단개문추관확대추판성형술환자적림상화영상학자료진행회고성분석.통계일본골과협회경수공능평분(JOA)급개선솔.비교술전급말차수방시X선측위편상C2추체시상면수직축선지C7추체후상연적거리(SVA);로저련선여C2추체하연련선적교각(Cobb각);T1추체상연련선여수평선적교각(T1-Slope),삼자분별반영경추전경정도、상경추전철정도이급경흉단후철정도.결과 수방평균16.7(3 ～40)개월.JOA평분유술전(12.2±0.3)분증지술후(14.6±0.2)분,개선솔위43.5％±4.2％.C2-C7 SVA、C0-2 Cobb각、T1-Slope각항술후여술전상비차이균유통계학의의(P=0.022,P＜0.001,P=0.002).C2-C7 SVA종술전(20.7 ±1.1)mm증가도(23.0±1.2) mm;C0-2 Cobb각종술전(19.9±0.8)°증가도(23.1±0.8)°;T1-Slope종술전(25.1±0.7)°증가도(26.2±0.7)°.C0-2 Cobb각변화이급T1-Slope변화분별여C2-C7 SVA적변화정정상관(Pearson=0.469,P＜0.001)、(Pearson=0.303,P=0.004).술후C2-C7 SVA、C0-2 Cobb각、T1-Slopes적변화여축성동통정도균무현저상관성(P=0.838,P=0.554,P=0.629).여술전T1-Slope교저적환자상비,술전T1-Slope교고적환자수술후JOA개선솔교저(31.5％비53.7％,P=0.019).결론 경후로단개문추관확대추판성형술후경추시상면평형출현현저변화,표현위경추향전경사,궤체지능통과상경추기육지속강력수축、보지상경추과도전철래대상.술전교고적T1-Slope장영향경추후로단개문수술적료효.
Objective To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty.Methods The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy.The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA,C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up.Results The average follow-up period was 16.7 (3-40) months.The post-operative JOA score rose to 14.6 ±0.2 from pre-operative 12.2 ±0.3 with 43.5％ ±4.2％ recovery rate.The post-operative values of C2-C7 SVA,C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P =0.022,P ＜0.001,P =0.002).C2-C7 SVA increased to (23.0 ± 1.2) mm from pre-operative (20.7 ± 1.1) mm.C0-2 Cobb angle increased (23.1 ± 0.8) ° from pre-operative (19.9 ± 0.8) ° ; T1-Slope increased to (26.2 ± 0.7) ° from pre-operative (25.1 ± 0.7) °.The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively (Pearson =0.469,P ＜ 0.001) (Pearson =0.303,P =0.004).Patients with higher preoperative T1-Slope had less JOA improvement(31.5％ vs 53.7％,P =0.019)than those with lower preoperative T1-Slope after laminoplasty.Conclusion The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra.And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine.A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.