[1]彭兵 程招军 李巍 宋红艳 李帮 杨驰 翁伽 雷濡萌 熊波△.颈椎后路单开门椎管成形术后颈椎矢状位的影像学变化[J].中国中医骨伤科杂志,2018,26(01):39-42，47.
　PENG Bing CHENG Zhaojun LI Wei SONG Hongyan LI Bang YANG Chi WENG Jia LEI Rumeng XIONG Bo.Morphological Changes of Sagittal Position after Cervical Expansive Open-door Laminoplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2018,26(01):39-42，47.
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颈椎后路单开门椎管成形术后颈椎矢状位的影像学变化()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第26卷
期数:
2018年01期
页码:
39-42，47
栏目:
临床论著
出版日期:
2018-01-15

文章信息/Info

Title:
Morphological Changes of Sagittal Position after Cervical Expansive Open-door Laminoplasty
文章编号:
1005-0205(2018)01-0039-04
作者:
彭兵1 程招军2 李巍1 宋红艳1 李帮1 杨驰1 翁伽1 雷濡萌1 熊波1△
1湖南浏阳市中医医院(湖南 浏阳,410300) 2天津中医药大学
Author(s):
PENG Bing1 CHENG Zhaojun2 LI Wei1 SONG Hongyan1 LI Bang1 YANG Chi1 WENG Jia1 LEI Rumeng1 XIONG Bo1△
1Liuyang Hospital of Traditional Chinese Medicine, Liuyang 410300,Hunan China; 2Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
关键词:
单开门椎管成形术;  矢状位参数;  脊髓型颈椎病
Keywords:
Keywords: expansive door-open laminoplasty;  sagittal parameters;  cervical spondylotic myelopathy
分类号:
R681.5
文献标志码:
A
摘要:
目的:探讨脊髓型颈椎病患者行颈椎后路单开门椎管成形术后颈椎矢状位影像学参数变化。方法:回顾性分析本院2012年1月至2016年11月59例接受颈椎后路单开门椎管扩大成形术的脊髓型颈椎病患者,随访12～24个月,术前常规行颈椎动力位片(站立位)摄片、颈椎CT、颈椎MRI及末次随访时行颈椎正侧位(站立位)摄片,并测量颈椎矢状位参数,其中包括C2～C7 Cobb角、T1 倾斜角(T1-Slope T1S)、C2～C7矢状位轴向距离(C2～C7 Sagittal Vertical Axis,C2～C7 SVA),颈椎曲度丢失。根据术前T1S值中位数的大小分为较大的T1S值组(T1S≥23.0°,n=29)与较小的T1S值组(T1S<23.0°,n=30)。结果:共有59例入选:其中男30例,女29例; 年龄32～74岁,平均(57.12±10.09)岁。随访12～24个月,平均(14.4±3.9)个月。手术节段为C3～750例,C3～6 9例,手术时间(136.69±42.65)min,出血量(178.81±105.12)mL,男女性别无差异。T1S由术前的24.15°±8.22°降为21.00°±6.44°,Cobb角由术前的21.51°±8.08°降为14.25°±5.01°,C2～C7 SVA由术前的(14.63±6.79)mm增至(19.31±7.37)mm,且三个参数术前及末次随访相比差异有统计学意义。将术前的T1S的中位数的大小分为A组(T1S<23.0°与B组(T1S≥23.0°)。两组组间对比发现术前的Cobb角(t=2.803,P=0.007)和 C2～C7 SVA(t=1.889,P=0.064)。同时两组组间对比发现术后的Cobb角(t=2.295,P=0.025)、C2～C7 SVA(t=0.998,P=0.323)和LcL(t=2.465,P=0.017)。术前颈椎矢状位参数相关性:T1S与C2～C7 SVA(r=0.313,P=0.160)、Cobb角(r=0.592,P<0.001)两者存在相关性,而C2～C7 SVA与Cobb角(r=-0.029,P=0.829)两者不存在相关性。结论:颈椎后路单开门椎管成形术后会造成颈椎曲度的丢失,术前较大的T1S值(T1S≥23.0°)有更多的颈椎前凸角,但术后发生颈椎曲度丢失的可能性较大。
Abstract:
Abstract Objective:To investigate the changes of cervical sagittal parameters in patients with cervical spondylosis myelopathy after cervical expansive door-open laminoplasty. Methods: A retrospective analysis was performed in 59 patients with cervical spondylotic myelopathy who undergoing cervical open-door laminoplasty in our hospital during January 2012 November 2016. The follow-up time was 12～24 months. The cervical flexion-extension X-ray, cervical CT scan and MRI before operation and the anteroposterior and lateral radiographs(standing shooting)at the last follow-up were routinely performed. And the cervical sagittal parameters including C2～C7 Cobb's angle, T1-Slope, C2～C7 sagittal vertical axis(C2～C7 SVA)and loss of cervical curvature were measured. According to the median size of T1S value before operation, it was divided into larger T1S group(T1S≥23.0°,n=29)and smaller T1S group(T1S<23.0°,n=30). Results: A total of 59 patients were selected, including 30 males and 29 females, aged 32～74 years, mean(57.12±10.09)years, followed up for 12～24 months, mean(14.4±3.9)months. There were 50 cases of C3～7 and 9 cases of C3～6. The operation time was(136.69±42.65)min and the amount of bleeding was(178.81±105.12)mL, and there was no difference between male and female. T1S decreased from 24.15 °±8.22 °before operation to 21.00 °±6.44 °, Cobb angle decreased from 21.51 °±8.08 ° to 14.25 °±5.01 °, and C2～C7 SVA increased from preoperative(14.63±6.79)mm to(19.31±7.37)mm, and the three parameters before the operation were statistically different from that of the last follow-up. The median value of preoperative T1S was divided into group A(T1S ≥23.0°)and B(T1S<23.0°). Between the two groups, there were statistically significant differences in the Cobb angle(t=2.803,P=0.007)and C2～C7 SVA(t=1.889,P=0.064)before the operation,and there were statistical differences in the Cobb angle(t=2.295,P=0.025), C2～C7 SVA(t=0.998,P=0.323)and LcL(t=2.465,P=0.017)after the operation. The correlation of preoperative cervical sagittal parameters: there was a correlation between T1S and C2～C7 SVA(r=0.313,P=0.160)and Cobb angles(r=0.592,P<0.001). There is no correlation between C2～C7 SVA and Cobb angle(r=0.029,P=0.829). Conclusion:The posterior open-door laminoplasty can cause the loss of cervical curvature. Despite the more cervical lordosis preoperatively, the patients with larger values of T1S(T1S≥23.0°)have the possibility of a larger loss of cervical curvature.

参考文献/References:

[1] 李玉伟,王海蛟,严晓云,等.颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析[J].中国脊柱脊髓杂志,2013,23(11):973-978.
[2] Suk KS,Kim KT,Lee JH,et al.Sagittal alignment of the cervical spine after the laminoplasty[J].Spine(Phila Pa 1976),2007,32(23):E656-E660.
[3] Yang M,Yang C,Ni H,et al.The Relationship between T1 Sagittal Angle and Sagittal Balance:A Retrospective Study of 119 Healthy Volunteers[J].PLoS One,2016,11(8):e160957.
[4] Lee SH,Kim KT,Seo EM,et al.The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults[J].J Spinal Disord Tech,2012,25(2):E41-E47.
[5] 福嘉欣,江毅,江汉,等.T1斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨[J].中国矫形外科杂志,2015,23(15):1360-1364.
[6] Cho JH,Ha JK,Kim DG,et al.Does preoperative T1 slope affect radiological and functional outcomes after cervical laminoplasty?[J].Spine(Phila Pa 1976),2014,39(26):E1575-E1581.
[7] Lin S,Zhou F,Sun Y,et al.Changes of sagittal balance of cervical spine after open-door expansive laminoplasty[J].Zhonghua Yi Xue Za Zhi,2014,94(35):2726-2730.
[8] Roguski M,Benzel EC,Curran JN,et al.Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2014,39(25):2070-2077.
[9] Smith JS,Lafage V,Ryan DJ,et al.Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume:analysis of 56 preoperative cases from the AOSpine North America Myelopathy study[J].Spine(Phila Pa 1976),2013,38(22 Suppl 1):S161-S170.
[10] 苗洁,申勇,王林峰,等.颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察[J].中国矫形外科杂志,2012,20(11):978-981.
[11] 臧法智,陈华江,王建喜,等.T1倾斜角对颈椎后纵韧带骨化患者后路单开门椎板成形术后颈椎曲度的影响[J].脊柱外科杂志,2016,14(1):26-29.
[12] Zhang JT,Li JQ,Niu RJ,et al.Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy[J].Eur Spine J,2017,26(4):1205-1210.
[13] 张浩,周文超,陈元元,等.颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系[J].中国脊柱脊髓杂志,2016,26(3):206-210.

备注/Memo

备注/Memo:
△通信作者 E-mail:422542031@qq.com
更新日期/Last Update: 2018-01-15