过度撑开对颈椎前路椎间盘切除融合术后轴性症状发生的影响。
Impact of over distraction on occurrence of axial symptom after anterior cervical discectomy and fusion.
作者信息
Bai Jiayue, Zhang Xin, Zhang Di, Ding Wenyuan, Shen Yong, Zhang Wei, Du Mengzhen
机构信息
Department of Hebei Orthopaedics, The Third Hospital of Hebei Medical University139# Ziqiang Road, Shijiazhuang 050000, Hebei Province, China; Key Biomechanical Laboratory of Orthopedics139# Ziqiang Road, Shijiazhuang 050000, Hebei Province, China.
Department of English Teaching, Hebei Medical University 361# Zhongshan East Road, Shijiazhuang, 050000, Hebei Province, China.
出版信息
Int J Clin Exp Med. 2015 Oct 15;8(10):19746-56. eCollection 2015.
OBJECTIVE
A retrospective review was undertaken to evaluate the impact of over distraction on cervical axial symptoms (AS) after anterior cervical discectomy and fusion (ACDF).
METHODS
The retrospective review included 421 patients who underwent ACDF for one or two segments. Of these, 78 patients for whom complete follow-up data were available were selected for inclusion in the analysis. X-rays of the cervical vertebra were performed immediately after the surgery, 3 months postsurgery, and at a final follow up (6-24 months). According to the presence/absence of AS, the patients were divided into a symptom group (Group S) and a nonsymptom group (Group N). The ratio of intervertebral height change, change in the overall cervical curvature, change in the local curvature of the surgical segment, cervical total range of motion (ROM), and Japanese Orthopaedic Association (JOA) recovery rate were compared and analyzed. A linear regression analysis of the ratio of intervertebral height change and the symptom and severity of the AS according to the Visual Analogue Scale (VAS) was carried out.
RESULTS
The total incidence of AS was 33.97%. C5 nerve root palsy occurred in one case in Group S after the surgery. The neurologic symptoms of both groups were significantly alleviated after the surgery. The ratio of intervertebral height change in Group S was significantly higher than that in Group N at the last follow-up (P < 0.05). However, the changes in the overall cervical curvature, local curvature of the surgical segment, cervical ROM, and JOA recovery rates were not statistically significant (P > 0.05). In Group S, 37% of the patients had symptoms that occurred in the chest area, and the ratio of intervertebral height change was significantly positively correlated with the VAS score of the AS (r = 0.893).
CONCLUSIONS
The occurrence of postoperative AS will significantly increase if the ratio of intervertebral height change of the surgical segment after ACDF is over 10%.
目的
进行一项回顾性研究，以评估前路颈椎间盘切除融合术（ACDF）后过度撑开对颈椎轴向症状（AS）的影响。
方法
该回顾性研究纳入了421例行单节段或双节段ACDF的患者。其中，选取78例有完整随访数据的患者纳入分析。术后即刻、术后3个月及末次随访（6 - 24个月）时均拍摄颈椎X线片。根据是否存在AS，将患者分为症状组（S组）和无症状组（N组）。比较并分析椎间高度变化率、颈椎整体曲度变化、手术节段局部曲度变化、颈椎总活动度（ROM）及日本骨科协会（JOA）恢复率。对椎间高度变化率与根据视觉模拟量表（VAS）评估的AS症状及严重程度进行线性回归分析。
结果
AS的总发生率为33.97%。S组术后有1例发生C5神经根麻痹。两组术后神经症状均明显缓解。末次随访时，S组椎间高度变化率显著高于N组（P < 0.05）。然而，颈椎整体曲度、手术节段局部曲度、颈椎ROM及JOA恢复率的变化无统计学意义（P > 0.05）。在S组中，37%的患者症状出现在胸部区域，椎间高度变化率与AS的VAS评分呈显著正相关（r = 0.893）。
结论
ACDF术后手术节段椎间高度变化率超过10%时，术后AS的发生率将显著增加。
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