Xie Jian-Xin, Chen Qi-Xin
Department of Orthopaedics, the 2nd Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China.
Department of Orthopaedics, the 2nd Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China;
Zhongguo Gu Shang. 2016 Oct 25;29(10):947-953. doi: 10.3969/j.issn.1003-0034.2016.10.014.
To investigate the anterior slip phenomenon of the vertebrae after corpectomy surgery and its clinical significance.
The clinical data of 164 patients with cervical spondylotic myelopathy treated from January 2010 to April 2013 were retrospectively analyzed. There were 88 males and 76 females, aged from 38 to 74 years old with the mean of 56.2 years. Among them, 31 cases for C₄ corpectomy, 87 cases for C₅ corpectomy, 46 cases for C₆ corpectomy. Preoperative and postoperative distance of posterior wall of vertebral canal to the line of adjacent upper vertebral bodies anterosuperior border and lower vertebral bodies anteroinferior border was measured by CT in cervical sagittal middle layer scanning as the center, anterior slip degree of the vertebrae after operation was evaluated. The fast clustering method was used, the vertebral shift distance as variable, according to the size of the forward distance, 90 cases classified as group 1(forward greatly group), and the 74 cases classified as group 2(forwad short group). The relationships on the anterior slip of the vertebrae and cervical curvature, surgical segment were analyzed. Japanese Orthopaedic Association (JOA) scores and its improvement rate were observed before and after operation, and the relationships on the anterior slip of the vertebrae and sagittal plane diagonal diameter of spinal canal, clinical effect were analyzed.
All the patients were followed up from 12 to 48 months with an average of 29.5 months. All operative vertebrae occurred anterior slip with different degree after corpectomy surgery, the maximum was 3.52 mm and minimum was 1.12 mm, with an average of (2.14±1.02) mm. According to the clustering method, the anterior slip distance with (3.07±0.21) mm classified as forward greatly group(90 cases, 54.9%) and the anterior slip distance with (1.55±0.32) mm classified as forwad short group(74 cases, 45.1%). There was no significant difference between anterior slip distance and operation segments(=0.01, =0.996). Cervical curvature index and anterior slip distance of operated vertebra had a positive correlation (=0.724). The incidence of reduction of the diagonal diameter of cervical spinal canal in forward greatly group was higher than that of forwad short group(=4.45, =0.035). The patients with unsatisfactory efficacy appeared obvious anterior slip of the vertebrae after corpectomy than the patients with satisfactory efficacy(<0.05).
Corpectomy of the cervical spine can result in vertebral forward displacement trend, and obvious displacement may cause the secondary compression of the spinal cord.
探讨椎体次全切除术后椎体前滑脱现象及其临床意义。
回顾性分析2010年1月至2013年4月收治的164例脊髓型颈椎病患者的临床资料。其中男性88例，女性76例，年龄38～74岁，平均56.2岁。其中C₄椎体次全切除31例，C₅椎体次全切除87例，C₆椎体次全切除46例。以颈椎矢状面中层扫描为中心，通过CT测量术前及术后椎管后壁至相邻上位椎体前上缘与下位椎体前下缘连线的距离，评估术后椎体前滑脱程度。采用快速聚类法，以椎体移位距离为变量，根据前移距离大小，将90例分为1组（前移较大组），74例分为2组（前移较小组）。分析椎体前滑脱与颈椎曲度、手术节段的关系。观察术前、术后日本骨科学会（JOA）评分及其改善率，分析椎体前滑脱与椎管矢状径、临床疗效的关系。
所有患者随访12～48个月，平均29.5个月。所有手术椎体次全切除术后均发生不同程度的前滑脱，最大为3.52 mm，最小为1.12 mm，平均（2.14±1.02）mm。根据聚类法，前滑脱距离为（3.07±0.21）mm者为前移较大组（90例，54.9%），前滑脱距离为（1.55±0.32）mm者为前移较小组（74例，45.1%）。前滑脱距离与手术节段之间差异无统计学意义（=0.01，=0.996）。颈椎曲度指数与手术椎体前滑脱距离呈正相关（=0.724）。前移较大组颈椎椎管矢状径减小发生率高于前移较小组（=4.45，=0.0
