双节段前路颈椎自锁式融合器融合术后矢状位影像学参数的变化

发布时间：2018-05-19 13:30

本文选题：颈椎病 + 前路颈椎融合术　；参考：《中国脊柱脊髓杂志》2016年02期

【摘要】：目的 :观察应用自锁式融合器行前路颈椎融合术(anterior cervical discectomy and fusion,ACDF)后矢状位影像学参数的变化。方法:回顾性分析2010年1月~2014年6月160例接受ACDF的双节段颈椎病患者,其中应用MC+融合器(单锚定组)78例,ROI-C融合器(双锚定组)82例。测量术前、术后3d、术后3个月及末次随访时颈椎侧位X线片的影像学参数,包括手术节段椎间隙高度(height of operation segment,HOS)、椎间隙角度(angle of operation segment,AOS)、C2-C7角、C2-C7矢状位轴向距离(C2-C7 sagittal vertical axis,C2-C7 SVA)及T1倾斜角(T1 slope,T1S),并应用Erk五度分级法评价术后3个月及末次随访时的植骨融合情况。采用Pearson相关性分析160例患者各时间点影像学参数间的相关性;运用独立样本t检验对比同时间点两组间各影像学参数的差异;使用配对样本t检验分别对两组组内不同时间点时各参数进行对比;两组间术后3个月及末次随访时的融合等级对比采用Mann-Whitney U检验;术后3个月及末次随访时两组组内融合等级对比运用Wilcoxon符号秩检验。结果:术后随访13.42±6.01个月(6~31个月)。术前、术后3d、术后3个月及末次随访时AOS与C2-C7角、C2-C7角与T1S、AOS与T1S、T1S与C2-C7 SVA均呈正相关(P0.01),C2-C7SVA与AOS、C2-C7角均无显著相关性(P0.01)。术后3d、3个月及末次随访时两组HOS、AOS、C2-C7角及T1S较术前均有增加(P0.05),术后3个月及末次随访时,双锚定组AOS、C2-C7角及T1S均高于单锚定组,两组比较存在统计学差异(P0.05)。两组术后3个月及末次随访时融合等级对比无统计学差异(P0.05),末次随访时两组融合等级较术后3个月时下降(P0.05)。结论:应用两种自锁式融合器行双节段ACDF均可恢复手术节段椎间隙的高度、角度以及颈椎曲度,ROI-C融合器较MC+融合器对维持术后手术节段角度及颈椎前凸更具优势。ACDF术后颈椎曲度的丢失可能引起胸椎矢状位影像学参数的变化。
[Abstract]:Objective: to observe the changes of sagittal imaging parameters after anterior cervical discectomy and fusion with self-locking fusion cage. Methods: one hundred and sixty patients with double-segment cervical spondylosis receiving ACDF from January 2010 to June 2014 were analyzed retrospectively. Among them, 78 cases in single anchoring group were treated with MC fusion cage (82 cases in double anchoring group). The imaging parameters of lateral cervical radiography were measured before, 3 days after operation, 3 months after operation and at the last follow-up. It included height of operation segment in surgical segment, angle of operation segmenting, angle of intervertebral space angle, C 2-C 7 angle of C 2-C 7 sagittal position, and T 1 slopeT 1s of T 1 oblique angle. The fusion of bone graft was evaluated by Erk five-degree classification method at 3 months after operation and at the last follow-up. Pearson correlation was used to analyze the correlation of imaging parameters at different time points in 160 patients, and the difference of imaging parameters between the two groups at the same time point was compared by independent sample t-test. The parameters at different time points in the two groups were compared by paired t-test, and the fusion grade at 3 months after operation and at the last follow-up between the two groups were compared with Mann-Whitney U test. Wilcoxon sign rank test was used to compare the grade of fusion between the two groups at 3 months after operation and at the last follow-up. Results: the postoperative follow-up was 13.42 卤6.01 months and ranged from 6 to 31 months. There was no significant correlation between C _ 2-C _ 7 angle of AOS and C2-C7 angle and C _ 2-C _ 7 angle of C2-C7 and T _ 1S and C2-C7 SVA at 3 days after operation and 3 months after operation. There was no significant correlation between C _ 2-C _ 7SVA and C _ 2-C _ 7 angle. At 3 days, 3 months and the last follow-up, the angle and T1S of the two groups were significantly higher than those of the preoperative group (P 0.05). At 3 months and the last follow-up, the AOSS-C2-C7 angle and T1S in the double anchoring group were higher than those in the single anchoring group, and there was a statistical difference between the two groups (P0.05). There was no significant difference in the fusion grade between the two groups at 3 months after operation and at the last follow-up, but at the last follow-up, the fusion grade of the two groups was lower than that at 3 months after operation. Conclusion: using two kinds of self-locking fusion cage to perform two-level ACDF can restore the height of the intervertebral space. Angle and cervical curvature ROI-C fusion cage has more advantages than MC fusion cage in maintaining postoperative segmental angle and cervical kyphosis. The loss of cervical curvature after ACDF may cause the changes of sagittal imaging parameters of thoracic vertebrae.
【作者单位】：南方医科大学第三附属医院广东省骨科研究院脊柱外科;
【基金】：广东省科技计划项目(编号:412018908043)
【分类号】：R687.3

【相似文献】