糖尿病性颈椎病患者椎板成形术后残留症状的特征：一项前瞻性队列研究
Characteristics of Residual Symptoms After Laminoplasty in Diabetic Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study.
作者信息
Machino Masaaki, Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Matsumoto Akiyuki, Tanaka Satoshi, Morozumi Masayoshi, Ito Keigo, Kato Fumihiko, Nishida Yoshihiro, Ishiguro Naoki
机构信息
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan.
出版信息
Spine (Phila Pa 1976). 2017 Jun 15;42(12):E708-E715. doi: 10.1097/BRS.0000000000001947.
STUDY DESIGN
A prospective cohort study.
OBJECTIVE
The purpose of this study was to compare cervical laminoplasty outcomes between diabetic and nondiabetic patients with cervical spondylotic myelopathy (CSM), and to characterize residual symptoms of diabetic patients.
SUMMARY OF BACKGROUND DATA
Diabetes is one of the most frequent comorbidities in CSM patients. However, no report has elucidated residual symptoms following surgery in diabetic patients with CSM.
METHODS
.: A total of 505 consecutive patients with CSM (331 males, 189 females; mean age, 66.6 years; age range, 41-91 years; >1-year follow up after laminoplasty) were enrolled and divided into diabetic group (n = 105) and nondiabetic group (n = 400). The Japanese Orthopedic Association (JOA) scores and recovery rate (RR) of each function were compared between the groups. To quantitatively assess performance, the 10-s grip and release (G&R) test and the 10-s step test were evaluated.
RESULTS
There was no significant difference in the mean RRs of upper extremity motor function between diabetic and nondiabetic patients (59.2% vs. 60.5%, respectively; P = 0.789). The RR of lower extremity motor function was lower in the diabetic group than in the nondiabetic group (36.1% vs. 43.4%, respectively; P = 0.047); the RR of upper extremity sensory function also was lower (36.8% vs. 49.6%, respectively; P = 0.006). However, the mean RRs of sensory functions of lower extremities were 59.7% (diabetic) and 59.2% (nondiabetic) (P = 0.953). There was no significant difference in the mean RRs of trunk sensory function between the groups (69.3% vs. 74.1%, respectively; P = 0.303). The mean RRs of urinary bladder function were 42.1% (diabetic) and 53.7% (nondiabetic) (P = 0.035). The preoperative mean number of the 10-s step test was lower in the diabetic group than in the nondiabetic group, and the postoperative mean number also was significantly lower in the diabetic group.
CONCLUSION
Gait disturbance, hand numbness, and bladder dysfunction after surgery persisted more than other symptoms in the diabetic than in the nondiabetic patients.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
本研究旨在比较糖尿病和非糖尿病脊髓型颈椎病（CSM）患者颈椎椎板成形术的疗效，并描述糖尿病患者的残留症状。
背景资料总结
糖尿病是CSM患者中最常见的合并症之一。然而，尚无报告阐明糖尿病CSM患者术后的残留症状。
方法
纳入505例连续的CSM患者（男331例，女189例；平均年龄66.6岁；年龄范围41 - 91岁；椎板成形术后随访>1年），分为糖尿病组（n = 105）和非糖尿病组（n = 400）。比较两组间日本骨科协会（JOA）评分及各功能的恢复率（RR）。为定量评估功能，评估10秒握力和放松（G&R）试验以及10秒步速试验。
结果
糖尿病和非糖尿病患者上肢运动功能的平均RRs无显著差异（分别为59.2%和60.5%；P = 0.789）。糖尿病组下肢运动功能的RR低于非糖尿病组（分别为36.1%和43.4%；P = 0.047）；上肢感觉功能的RR也较低（分别为36.8%和49.6%；P = 0.006）。然而，下肢感觉功能的平均RRs在糖尿病组和非糖尿病组分别为59.7%和59.2%（P = 0.953）。两组间躯干感觉功能的平均RRs无显著差异（分别为69.3%和74.1%；P = 0.303）。膀胱功能的平均RRs在糖尿病组和非糖尿病组分别为42.1%和53.7%（P = 0.035）。糖尿病组术前10秒步速试验的平均次数低于非糖尿病组，术后糖尿病组的平均次数也显著更低。
结论
与非糖尿病患者相比，糖尿病患者术后步态障碍、手部麻木和膀胱功能障碍比其他症状持续时间更长。
证据级别
2级。
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