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接受钢板固定联合椎板成形术治疗的后纵韧带骨化症患者与颈椎病患者在活动范围、颈部疼痛和预后方面是否存在差异?

Is there a difference in range of motion, neck pain, and outcomes in patients with ossification of posterior longitudinal ligament versus those with cervical spondylosis, treated with plated laminoplasty?

机构信息

Department of Neurosurgery, University of California, San Francisco, California, USA.

出版信息

Neurosurg Focus. 2013 Jul;35(1):E9. doi: 10.3171/2013.4.FOCUS1394.


DOI:10.3171/2013.4.FOCUS1394
PMID:23815254
Abstract

OBJECT: There are little data on the effects of plated, or plate-only, open-door laminoplasty on cervical range of motion (ROM), neck pain, and clinical outcomes. The purpose of this study was to compare ROM after a plated laminoplasty in patients with ossification of posterior longitudinal ligament (OPLL) versus those with cervical spondylotic myelopathy (CSM) and to correlate ROM with postoperative neck pain and neurological outcomes. METHODS: The authors retrospectively compared patients with a diagnosis of cervical stenosis due to either OPLL or CSM who had been treated with plated laminoplasty in the period from 2007 to 2012 at the University of California, San Francisco. Clinical outcomes were measured using the modified Japanese Orthopaedic Association (mJOA) scale and neck visual analog scale (VAS). Radiographic outcomes included assessment of changes in the C2-7 Cobb angle at flexion and extension, ROM at C2-7, and ROM of proximal and distal segments adjacent to the plated lamina. RESULTS: Sixty patients (40 men and 20 women) with an average age of 63.1 ± 10.9 years were included in the study. Forty-one patients had degenerative CSM and 19 patients had OPLL. The mean follow-up period was 20.9 ± 13.1 months. The mean mJOA score significantly improved in both the CSM and the OPLL groups (12.8 to 14.5, p < 0.01; and 13.2 to 14.2, respectively; p = 0.04). In the CSM group, the mean VAS neck score significantly improved from 4.2 to 2.6 after surgery (p = 0.01), but this improvement did not reach the minimum clinically important difference (MCID). Neither was there significant improvement in the VAS neck score in the OPLL group (3.6 to 3.1, p = 0.17). In the CSM group, ROM at C2-7 significantly decreased from 32.7° before surgery to 24.4° after surgery (p < 0.01). In the OPLL group, ROM at C2-7 significantly decreased from 34.4° to 20.8° (p < 0.01). In the CSM group, the change in the VAS neck score significantly correlated with the change in the flexion angle (r = - 0.31) and the extension angle (r = - 0.37); however, it did not correlate with the change in ROM at C2-7 (r = - 0.1). In the OPLL group, the change in the VAS neck score did not correlate with the change in the flexion angle (r = 0.03), the extension angle (r = - 0.17), or the ROM at C2-7 (r = - 0.28). The OPLL group had a significantly greater loss of ROM after surgery than did the CSM group (p = 0.04). There was no significant correlation between the change in ROM and the mJOA score in either group. CONCLUSIONS: Plated laminoplasty in patients with either OPLL or CSM decreases cervical ROM, especially in the extension angle. Among patients who have undergone laminoplasty, those with OPLL lose more ROM than do those with CSM. No correlation was observed between neck pain and ROM in either group. Neither group had a change in neck pain that reached the MCID following laminoplasty. Both groups improved in neurological function and outcomes.

摘要

目的:关于板固定或仅板固定的开门式椎板成形术对颈椎活动度(ROM)、颈部疼痛和临床结果的影响,相关数据较少。本研究的目的是比较伴有后纵韧带骨化(OPLL)与伴有脊髓型颈椎病(CSM)的患者接受板固定椎板成形术后的 ROM,并将 ROM 与术后颈部疼痛和神经功能结果相关联。

方法:作者回顾性比较了 2007 年至 2012 年期间在加利福尼亚大学旧金山分校接受板固定椎板成形术治疗的因颈椎狭窄而诊断为 OPLL 或 CSM 的患者。使用改良日本矫形协会(mJOA)量表和颈部视觉模拟量表(VAS)来评估临床结果。影像学结果包括评估颈椎屈伸时 C2-7 Cobb 角的变化、C2-7 的 ROM 以及固定板相邻近端和远端节段的 ROM。

结果:60 名患者(40 名男性和 20 名女性)的平均年龄为 63.1±10.9 岁,纳入研究。41 名患者患有退行性 CSM,19 名患者患有 OPLL。平均随访时间为 20.9±13.1 个月。CSM 和 OPLL 组的平均 mJOA 评分均显著改善(分别从 12.8 提高到 14.5,p<0.01;和从 13.2 提高到 14.2,p=0.04)。在 CSM 组中,术后颈部 VAS 评分从 4.2 显著改善至 2.6(p=0.01),但这一改善未达到最小临床重要差异(MCID)。OPLL 组的颈部 VAS 评分无显著改善(从 3.6 改善至 3.1,p=0.17)。在 CSM 组中,C2-7 的 ROM 从术前的 32.7°显著减少至术后的 24.4°(p<0.01)。在 OPLL 组中,C2-7 的 ROM 从术前的 34.4°显著减少至术后的 20.8°(p<0.01)。在 CSM 组中,颈部 VAS 评分的变化与屈伸角的变化显著相关(r=-0.31)和伸展角(r=-0.37);然而,它与 C2-7 的 ROM 变化无关(r=-0.1)。在 OPLL 组中,颈部 VAS 评分的变化与屈伸角(r=0.03)、伸展角(r=-0.17)或 C2-7 的 ROM(r=-0.28)均无相关性。OPLL 组术后 ROM 丢失量明显大于 CSM 组(p=0.04)。两组的 ROM 变化与 mJOA 评分均无显著相关性。

结论:OPLL 或 CSM 患者的板固定椎板成形术会降低颈椎 ROM,尤其是在伸展角度。在接受椎板成形术的患者中,OPLL 患者比 CSM 患者丢失更多的 ROM。两组患者的颈部疼痛均未达到 MCID。两组患者在接受椎板成形术后,神经功能和结果均有改善。

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[7]
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[8]
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