Department of Orthopaedics, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
J Orthop Surg Res. 2023 Apr 26;18(1):323. doi: 10.1186/s13018-023-03805-6.
Cervical spondylotic myelopathy preoperative prognostic factors include age, preoperative severity, and disease duration. However, there are no reports on the relationship between changes in physical function during hospitalization and postoperative course, and in recent years, the length of hospital stay has shortened. We aimed to investigate whether changes in physical function during hospitalization can predict the postoperative outcome.
We recruited 104 patients who underwent laminoplasty for cervical spondylotic myelopathy by the same surgeon. Physical functions, including Simple Test for Evaluating Hand Function (STEF), grip strength, timed up and go test, 10-m walk, and time to stand on one leg, were assessed at admission and discharge. Patients with the Japanese Orthopaedic Association (JOA) score improvement rate of 50% or more were defined as the improved group. Decision tree analysis was investigated factor for identifying improvement in the JOA score. According to this analysis, we divided into two groups using age. Then, we conducted a logistic regression analysis to identify factors that improve the JOA score.
The improved and non-improved groups had 31 and 73 patients, respectively. The improved group was younger (p = 0.003) and had better improved Δgrip strength (p = 0.001) and ΔSTEF (p < .0007). Age was significantly positively correlated with disease duration (r = 0.4881, p = < .001). Disease duration exhibited a significant negative correlation with the JOA score improvement rate (r = - 0.2127, p = 0.031). Based on the decision tree analysis results, age was the first branching variable, with 15% of patients ≥ 67 years showing JOA score improvement. This was followed by ΔSTEF as the second branching factor. ΔSTEF was selected as the factor associated with JOA improvement in patients ≥ 67 years (odds ratio (OR) 0.95, 95% confidence interval (CI) 0.90-0.99, p = .047); in patients < 67 years, Δgrip strength was identified (OR 0.53, CI 0.33‒0.85, p = .0086).
In the improved group, upper limb function improved more than lower limb function from the early postoperative period. Upper limb function changes during hospitalization were associated with outcomes one year postoperatively. Improvement factors in upper extremity function differed by age, with changes in grip strength in patients < 67 years and STEF in patients ≥ 67 years, reflecting the outcome at one year postoperatively.
颈椎脊髓病术前预后因素包括年龄、术前严重程度和疾病持续时间。然而，目前尚无关于住院期间身体功能变化与术后病程之间关系的报道，而且近年来住院时间缩短。我们旨在研究住院期间身体功能的变化是否可以预测术后结果。
我们招募了由同一位外科医生进行颈椎脊髓病椎板成形术的 104 例患者。在入院和出院时评估身体功能，包括简易手部功能测试（STEF）、握力、计时起立行走测试、10 米步行和单腿站立时间。日本骨科协会（JOA）评分改善率达到 50%或以上的患者被定义为改善组。决策树分析用于确定识别 JOA 评分改善的因素。根据该分析，我们使用年龄将患者分为两组。然后，我们进行逻辑回归分析以确定改善 JOA 评分的因素。
改善组和未改善组分别有 31 例和 73 例患者。改善组年龄较小（p=0.003），改善后的握力（p=0.001）和 STEF（p<0.0007）更高。年龄与疾病持续时间呈显著正相关（r=0.4881，p<0.001）。疾病持续时间与 JOA 评分改善率呈显著负相关（r=-0.2127，p=0.031）。基于决策树分析结果，年龄是第一个分支变量，有 15%的年龄≥67 岁的患者 JOA 评分改善。其次是 STEF 作为第二个分支因素。STEF 被选为年龄≥67 岁患者与 JOA 改善相关的因素（优势比（OR）0.95，95%置信区间（CI）0.90-0.99，p=0.047）；在年龄<67 岁的患者中，确定了握力的改善（OR 0.53，CI 0.33-0.85，p=0.0086）。
在改善组中，术后早期上肢功能的改善程度大于下肢功能。住院期间上肢功能的变化与术后 1 年的结果相关。上肢功能改善的因素因年龄而异，年龄<67 岁的患者握力变化，年龄≥67 岁的患者 STEF 变化，反映了术后 1 年的结果。
