单节段颈前路椎间融合术后ROI-C融合器沉降的相关因素分析

发布时间：2018-08-02 10:05

【摘要】：目的 :分析采用ROI-C行颈前路单节段椎间盘切除减压融合(anterior cervical discectomy and fusion,ACDF)术后融合器沉降的相关因素。方法:回顾总结采用ROI-C行单节段ACDF治疗颈椎间盘退变性疾病的83例患者资料。记录患者年龄、性别、手术节段、吸烟史及骨密度检查结果。在术前颈椎侧位X线片上测量颈椎整体曲度(cervical alignment,CA)、融合节段角度(segmental angle,SA)、椎间隙前高度(anterior disc height,ADH)和椎间隙后高度(posterior disc height,PDH)。将随访的中立位颈椎侧位X线片与术后即刻比较,ADH或PDH丢失2mm判定为融合器沉降,分入沉降(subsidence)组(S组,22例),并记录沉降的部位;≤2mm分入未沉降(nonsubsidence)组(N组,61例)。应用独立样本t检验、χ~2检验对以上参数行组间比较,采用多变量Logistic回归分析单节段ACDF术后ROI-C沉降的危险因素。将危险因素进一步分组使用χ~2检验计算似然比(likelihood ratio,LR)进行评价。结果 :单节段ACDF术后ROI-C沉降发生率为26.5%(22/83),其中陷入椎体前方终板者占63.6%(14/22)。S组、N组年龄分别为59.86±12.11岁、52.77±10.34岁,差异有统计学意义(P=0.010);性别、吸烟史、手术节段和骨密度均无统计学差异(P0.05)。S组术前的CA、SA、ADH分别为-0.800°±5.637°、0.432°±2.162°和3.768±1.210mm,N组分别为4.893°±5.718°、1.198°±1.826°和5.066±1.257mm,两组比较差异有统计学意义(P0.001,P=0.031和P0.001),两组的PDH差异无统计学意义(P=0.092)。多变量Logistic回归分析显示术前CA和年龄是ROI-C沉降的危险因素(P=0.014和P=0.038)。根据术前CA情况将患者分为术前CA后凸(CA0°)和前凸(CA≥0°)组,根据术前年龄将患者分为60岁和≥60岁组,χ~2检验显示术前CA后凸和60岁以上病例ROI-C沉降概率分别比前凸和60岁以下病例高12.5倍和4.5倍(LR=12.529,P0.001;LR=4.454,P=0.030)。结论 :术前CA后凸和年龄60岁以上是单节段ACDF术后ROI-C沉降的危险因素。选择ROI-C行单节段ACDF治疗颈椎间盘退变性疾病时应考虑这两项因素的影响。
[Abstract]:Objective: to analyze the factors related to the reduction of fusion cage after anterior cervical discectomy and decompression and fusion of (anterior cervical discectomy and fusion (ACDF) with ROI-C. Methods: the data of 83 patients with cervical disc degeneration treated by single segment ACDF with ROI-C were retrospectively reviewed. Age, sex, surgical segment, smoking history and bone mineral density were recorded. The cervical curvature (CA), the angle of fusion segment (segmental angle SA), the height of anterior intervertebral space (anterior disc) and the height of posterior intervertebral space (posterior disc height) were measured on cervical lateral radiographs before operation. The lateral radiographs in the neutral position of cervical vertebrae were compared with those in the immediate after operation. The patients were divided into two groups: group S (n = 22) and group S (n = 22), and 鈮，

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