术前颈椎曲度与单开门椎管扩大成形术后临床疗效的相关性分析

Correlation Analysis between Preoperative Cervical Curvature and Clinical Outcomes after Expansive Open-Door Laminoplasty

摘要: 目的：研究术前颈椎曲度与慢性多节段脊髓型颈椎病患者在单开门椎管扩大成形术后临床疗效的相关性，为判断患者预后提供一定依据。方法：选取我院2015年1月~2022年12月因多节段脊髓型颈椎病而采用钛板支撑单开门椎管扩大成形术治疗的94例患者。根据术前X线片结果，以颈椎Cobb角为标准将患者分为A组(n = 26)、B组(n = 25)和C组(n = 43)，在颈椎MRI T2加权像中心矢状位片上测量并计算C3~C7各节段脊髓后移距离，比较三组患者C3~C7各节段脊髓后移距离差异，对患者术前及末次随访时神经功能(JOA评分)进行评价，计算三组患者末次随访时JOA评分改善率并比较其差异。结果：三组患者的年龄、性别、病程、术前JOA评分等无统计学差异(P > 0.05)。三组患者C3~C7各节段脊髓均有明显后移，但脊髓后移距离差异无统计学意义(P > 0.05)。三组患者末次随访时平均JOA改善率分别为53.22%、57.30和50%，差异无统计学意义(P > 0.05)。C5水平脊髓后移距离末次随访时JOA改善率无线性相关关系。结论：术前不同曲度的慢性脊髓型颈椎病患者术后均能获得不错的临床效果，JOA改善率与术前颈椎曲度、术后脊髓后移距离之间均无明显相关。

Abstract: Objective: To study the correlation between preoperative cervical curvature and clinical outcomes of chronic multilevel cervical spondylotic myelopathy patients after expansive open-door laminoplasty, and to provide a certain basis for judging the prognostic outcomes of patients. Methods: Ninety-four patients who were treated with ttitanium plate-supported expansive open-door laminoplasty for chronic cervical spondylotic myelopathy at our hospital from January 2015 to December 2022 were selected. Based on the results of preoperative radiographs, patients were categorized into the groups A (n = 26), B (n = 25) and C (n = 43) using the Cobb angle of the cervical spine as the criterion. The spinal cord posterior displacement distance at each level of laminoplasty (C3~C7) was measured and calculated through the midsagittal images of MRI T2-weighted. Statistic analysis was performed to analyze the difference of spinal cord posterior displacement distance at each level (C3~C7) among three groups. Neurologic function (JOA score) was evaluated preoperatively and at the final follow-up, and the improvement rate of JOA score at the final follow-up was calculated and compared between the three groups. Results: There was no statistical difference in age, gender, disease duration, and preoperative JOA score between the three groups (P > 0.05). There was significant posterior displacement of the spinal cord in all segments of C3~C7 in three groups, but there was no statistically significant difference in the distance of posterior displacement of the spinal cord (p > 0.05). The average JOA improvement rates at the last follow-up of the three groups were 53.22%, 57.30% and 50%, respectively, with no statistically significant difference (P > 0.05). There was no linear correlation between the spinal cord posterior displacement distance at the C5 level and the duration of the patient's disease and the JOA improvement rate at the last follow-up. Conclusion: The patients with chronic spinal cervical spondylosis with different preoperative curvatures have good clinical outcomes after surgery, there was no significant correlation between the JOA improvement rate and preoperative cervical curvature or postoperative spinal cord posterior displacement distance.