[1]周世博,赵学千,袁林,等.颈前路椎间盘切除减压融合联合颈椎间盘置换对三节段颈椎病矢状位指标的影响[J].中国中医骨伤科杂志,2022,30(09):47-52.
　ZHOU Shibo,ZHAO Xueqian,YUAN Lin,et al.Efficacy of Anterior Cervical Discectomy,Decompression and Fusion Combined with Cervical Total Disc Replacement on Sagittal Parameters of Three-Segment Cervical Spondylosis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(09):47-52.
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颈前路椎间盘切除减压融合联合颈椎间盘置换对三节段颈椎病矢状位指标的影响()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年09期
页码:
47-52
栏目:
临床研究
出版日期:
2022-09-15

文章信息/Info

Title:
Efficacy of Anterior Cervical Discectomy,Decompression and Fusion Combined with Cervical Total Disc Replacement on Sagittal Parameters of Three-Segment Cervical Spondylosis
文章编号:
1005-0205(2022)09-0047-06
作者:
周世博1; 赵学千2; 袁林1; 李亚锋1; 马慧1; 贾育松2△
1北京中医药大学第一临床医学院(北京,100029)
2清华大学中西医结合医院
Author(s):
ZHOU Shibo1; ZHAO Xueqian2; YUAN Lin1; LI Yafeng1; MA Hui1; JIA Yusong2△
1First Clinical School of Medicine,Beijing University of Chinese Medicine,Beijing 100029,China; 2Tsinghua University Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100043,China.
关键词:
颈前路;  椎间盘切除减压融合;  颈椎间盘置换;  三节段颈椎病;  矢状位指标
Keywords:
anterior cervical;  anterior cervical discectomy and fusion(ACDF);  cervical total disc replacement(cTDR);  three-segment cervical spondylosis;  sagittal parameters
分类号:
R681.5
文献标志码:
A
摘要:
目的:探讨颈椎前路三节段椎间盘切除减压融合+颈椎间盘置换手术后颈椎矢状位指标的变化。方法:回顾性分析2017年至2021年行颈椎前路三节段椎间盘切除减压融合+人工颈椎间盘置换术患者,通过Excel建立数据库,以胸1倾斜角(T1S)、C2～C7 Cobb角(C2～7 Cobb角)、C2～7矢状位轴向距离(C2～7 SVA)以及手术节段角(SA)为观察对象,分析患者术前及末次随访时上述数值的变化。采用配对样本t检验或非参数检验分析治疗前后是否存在差异,相关性分析使用Pearson或Spearman法。结果:共纳入26例患者,男17例,女9例; 年龄为34～80岁,平均为(62.88±11.49)岁; 随访2～52周,平均为(12.65±14.01)周。接受两节段人工颈椎间盘置换(Cervical Total Disc Replacement,cTDR)+单节段颈椎前路椎间盘切除减压融合术(Anterior Cervical Discectomy and Fusion,ACDF)22例,单节段cTDR+两节段ACDF 4例。Hybrid术后T1S、C2～7 Cobb角及SA较术前增加,差异有统计学意义(P<0.05); 治疗后Pearson相关性提示T1S与C2～7 Cobb角、T1S与SA、C2～7 Cobb角与SA及T1S与C2～7 SVA之间存在正相关性(P<0.05)。相关性大小为C2～7 Cobb角+SA>T1S+C2～7 Cobb角>T1S+SA>T1S+C2～7 SVA。结论:颈前路椎间盘切除减压融合联合颈椎间盘置换可以改善颈椎矢状位指标,起到恢复颈椎矢状位指标正常的作用。
Abstract:
Objective:To study the changes of sagittal parameters of cervical spine after three-segment anterior cervical discectomy,decompression and fusion combined with cervical total disc replacement operation in anterior cervical spine.Methods:A retrospective analysis of patients who underwent anterior cervical three-segment anterior cervical discectomy,decompression and fusion combined with cervical total disc replacement surgery from 2017 to 2021 was performed.The T1 inclination angle(T1S),C2～C7 Cobb angle(C2～7 Cobb angle),C2～7 sagittal axial distance(C2～7 SVA)and the surgical segment angle(SA)were observed,and the changes of the above values before surgery and at the last follow-up were analyzed.Paired samples t test or nonparametric test was used to analyze whether there was a difference before and after treatment; Pearson or Spearman method was used for correlation analysis.Results:A total of 20 patients were included,including 17 males and 9 females,aged from 34 to 80 years old,with(62.88±11.49)years old on average; follow-up time from 2 to 52 weeks,with(12.65±14.01)weeks on average.22 patients underwent two-level cervical disc replacement(cTDR)combined with single-level anterior cervical discectomy and fusion(ACDF),and 4 patients underwent single-level cTDR combined with two-level ACDF.Compared with preoperative data,T1S,C2～7 Cobb angle and SA increased after Hybrid,and the difference was statistically significant(P<0.05).Pearson correlation after treatment indicated positive correlation between T1S and C2～7 Cobb angle,between T1S and SA,between C2～7 Cobb angle and SA,and between T1S and C2～7 SVA(P<0.05).Correlation:C2～7 Cobb angle+SA>T1S+C2～7 Cobb angle>T1S+SA>T1S+C2～7 SVA.Conclusion:Multi-segment hybrid surgery can improve the sagittal parameters of the cervical spine and achieve the purpose of restoring the balance of the sagittal parameters of the cervical spine.

参考文献/References:

[1] BAI C,LI K,GUO A,et al.Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy[J].Medicine,2017,96(23):7043.
[2] 罗晓,刘康,杨维新.某医院2014-2016年颈椎病住院患者流行病学现状分析[J].解放军预防医学杂志,2018,36(1):124-126.
[3] 李沅骋,李开平,宋子琪,等.长期低头位与寒湿刺激建立颈型颈椎病动物模型的研究[J/OL].中华中医药学刊:1-20[2022-02-05].http://kns.cnki.net/kcms/detail/21.1546.r.20211229.2008.002.html.
[4] WEI L X,CAO P,XU C,et al.Comparison of three anterior techniques in the surgical treatment of three-level cervical spondylotic myelopathy with intramedullary T2-weighted increased signal intensity[J].World Neurosurgery,2019,126:842-845.
[5] VIJAYASARADHI M,KODE S,ALUGOLU R.Does the extent of soft tissue dissection and location of screws in anterior cervical discectomy and fusion impact the development of the adjacent segment degeneration? A prospective short term radiological analysis[J].Journal of Neuro Surgical Sciences,2021.DOI:10.23736/S0390-5616.21.05458-8.
[6] 黄康康,刘浩,丁琛,等.颈椎前路Hybrid手术不同组合方式治疗连续三节段颈椎病的疗效对比[J].中国脊柱脊髓杂志,2021,31(9):771-782.
[7] 徐野夫,王锋,吴小涛.颈椎矢状位平衡参数的研究进展[J].中国矫形外科杂志,2020,28(5):425-429.
[8] BARBAGALLO G M V,ASSIETTI R,CORBINO L,et al.Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease:opposite or complementary techniquess[J].Eur Spine J,2009,18(Supp1):29-39.
[9] KIM K N,YOON D H,SHIN D A,et al.Artificial disc replacement combined with fusion versus two level fusion in cervical two level disc disease[J].Spine(Phila Pa 1976),2009,34(11):1153-1159.
[10] 赵学千,李晋玉,刘楚吟,等.双节段人工颈椎间盘置换术治疗颈椎病后颈椎矢状位参数的变化研究[J].中国中医骨伤科杂志,2020,28(12):21-25.
[11] 汤洋,黄觅,胡敏,等.脊髓型颈椎病经ACDF术后临床疗效与颈椎矢状位参数变化的相关性分析[J].中国骨与关节损伤杂志,2021,36(9):932-934.
[12] 郭雨霞,李春根,柳根哲,等.颈椎前路Hybrid手术治疗颈椎病的疗效观察[J].中国脊柱脊髓杂志,2021,31(4):317-323.
[13] VITAL J M,SENEGAS J.Anatomical bases of the study of the constraints to which the cervical spine is subject in the sagittalplane.A study of the center of gravity of the head[J].Surg Radiol Anat,1986,8(3):169-173.
[14] DUDLI S,FIELDS A J,SAMARTZIS D,et al.Pathobiology of Modic changes[J].Eur Spine J,2016,25(11):3723-3734.
[15] 李毓吉,唐能能.颈椎矢状位平衡参数与颈椎间盘退变的相关性研究及临床意义[J].医学理论与实践,2021,34(8):1261-1264.
[16] WANG Z L,XIAO J L,MOU J H,et al.Analysis of cervical sagittal balance parameters in MRIs of patients with disc-degenerative disease[J].Med Sci Monit,2015,21(1):3083-3088.
[17] LEE J S,YOUN M S,SHIN J K,et al.Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis[J].Eur Spine J,2015,24(6):1199-1203.
[18] LIU J,LIU P,MA Z,et al.The effects of aging on the profile of the cervical[J].Spine Medicine(Baltimore),2019,98(7):e14425.
[19] TAMAI K,GRISDELA P JR,ROMANU J,et al.Kinematic characteristics of patients with cervical imbalance:a weight-bearing dynamic MRI study[J].Eur Spine J,2019,28(5):1200-1208.
[20] 陈群响,倪斌,韩钊.胸1倾斜角及其在脊柱矢状位平衡评价中的应用进展[J].中国脊柱脊髓杂志,2018,28(5):470-473.
[21] 曾祥鸿,梁博伟,谢克恭,等.脊髓型颈椎病ACDF术后近期颈椎矢状位参数的变化及意义[J].实用骨科杂志,2021,27(3):193-198.
[22] 杨胜,唐超,钟德君.150例健康成人下颈椎矢状位曲度相关影像学参数测量及临床意义[J].中国临床解剖学杂志,2020,38(5):549-553.
[23] LEE S H,KIM K T,SEO E M,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.
[24] XING R,LIU W,LI X,et,al.Characteristics of cervical sagittal parameters in healthy cer-vical spine adults and patients with cervical disc degeneration[J].BMC MusculoSkelet Disord,2018,19(1):37.
[25] OE S,YAMATO Y,TOGAWA D,et al.Preoperative T1 slope more than 40° as a risk factor of correction loss in patients with adult spinal deformity[J].Spine,2016,41(19):1168-1176.
[26] HUANG Y,LAN Z,XU W.Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical spondylotic myelopathy[J].BMC Musculoskeletal Disorders,2019,20(1):21-27.
[27] 鲁新垒,张静,郭海龙,等.颈椎矢状位参数在颈椎病诊治中的应用进展[J].中国脊柱脊髓杂志,2019,29(11):1033-1037.
[28] 周逸彬,李西成.C2-C7活动度预测脊髓型颈椎病症状严重程度的临床价值[J].颈腰痛杂志,2020,41(1):45-47.
[29] LYER S,NEMANI V M,NGUYEN J,et al.Impact of cervical sagittal alignment parameters on neck disability[J].Spine,2016,41(5):371-377.
[30] STAUB B N,LAFAGE R,KIM H J,et al.Cervical mismatch:the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis[J].J Neurosurg Spine,2018,30(1):31-37.
[31] 吴廷奎,胡旭,刘浩,等.单节段ACDR与ACDF治疗伴可复性反弓颈椎病的疗效比较[J].实用骨科杂志,2021,27(1):1-5.
[32] MCAVINEY J,SCHULZ D,BOCK R,et al.Determining the relationship betweencervical lordosis and neck complaints[J].J Manipulative Physiol Ther,2005,28(3):187-193.
[33] 席俊伟.颈椎矢状位参数变化对脊髓型颈椎病行ACDF手术疗效的影响[J].颈腰痛杂志,2020,41(5):544-547.
[34] 王建华,吴迪,孙贺,等.颈椎前路减压3D打印椎间融合器融合内固定术对颈椎矢状位参数的影响[J].中国脊柱脊髓杂志,2021,31(4):324-330.
[35] LE HUEC J C,DEMEZON H,AUNOBLE S.Sagittal parameters of globalcervical balance using EOS imaging:normative values from a prospective cohort of asymptomatic volunteers[J].Eur Spine J,2015,24(1):63-71.
[36] TANG J A,SCHEER J K,SMITH J S,et al.The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery[J].Neurosurgery,2015,76(Suppl 1):S14-S21.
[37] BADHIWALA J H,WITIW C D,NASSIRI F,et al.Patient phenotypes asso ciated with outcome following surgery for mild degenerative cervical myelopathy:a principal component regression analysis[J].Spine J,2018,18(12):2220-2231.

备注/Memo

备注/Memo:
△通信作者 E-mail:jiayusong@126.com
更新日期/Last Update: 2022-09-10