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学科主题: 骨科学
题名:
颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化
其他题名: Changes of sagittal balance of cervical spine after open-door expansive laminoplasty
作者: 林圣荣; 周非非; 孙宇; 陈仲强; 张凤山; 潘胜发
关键词: 椎管狭窄 ; 颈椎病 ; 颈椎 ; 矢状面平衡 ; Spinal stenosis ; Cervical spondylosis ; Cervical vertebrae ; Sagittal balance
刊名: 中华医学杂志
发表日期: 2014
DOI: 10.3760/cma.j.issn.0376-2491.2014.35.003
卷: 94, 期:35, 页:2726-2730
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 探索颈后路椎管扩大椎板成形术后颈椎矢状位平衡变化.方法 2008年1月至2011年7月北京大学第三医院骨科对90例因脊髓型颈椎病接受C3-C7颈后路单开门椎管扩大椎板成形术患者的临床和影像学资料进行回顾性分析.统计日本骨科协会颈髓功能评分(JOA)及改善率.比较术前及末次随访时X线侧位片上C2椎体矢状面垂直轴线至C7椎体后上缘的距离(SVA);颅底连线与C2椎体下缘连线的交角(Cobb角);T1椎体上缘连线与水平线的交角(T1-Slope),三者分别反映颈椎前倾程度、上颈椎前凸程度以及颈胸段后凸程度.结果 随访平均16.7(3 ~40)个月.JOA评分由术前(12.2±0.3)分增至术后(14.6±0.2)分,改善率为43.5%±4.2%.C2-C7 SVA、C0-2 Cobb角、T1-Slope各项术后与术前相比差异均有统计学意义(P=0.022,P<0.001,P=0.002).C2-C7 SVA从术前(20.7 ±1.1)mm增加到(23.0±1.2) mm;C0-2 Cobb角从术前(19.9±0.8)°增加到(23.1±0.8)°;T1-Slope从术前(25.1±0.7)°增加到(26.2±0.7)°.C0-2 Cobb角变化以及T1-Slope变化分别与C2-C7 SVA的变化呈正相关(Pearson=0.469,P<0.001)、(Pearson=0.303,P=0.004).术后C2-C7 SVA、C0-2 Cobb角、T1-Slopes的变化与轴性疼痛程度均无显著相关性(P=0.838,P=0.554,P=0.629).与术前T1-Slope较低的患者相比,术前T1-Slope较高的患者手术后JOA改善率较低(31.5%比53.7%,P=0.019).结论 颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡出现显著变化,表现为颈椎向前倾斜,机体只能通过上颈椎肌肉持续强力收缩、保持上颈椎过度前凸来代偿.术前较高的T1-Slope将影响颈椎后路单开门手术的疗效. Objective To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty.Methods The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy.The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA,C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up.Results The average follow-up period was 16.7 (3-40) months.The post-operative JOA score rose to 14.6 ±0.2 from pre-operative 12.2 ±0.3 with 43.5% ±4.2% recovery rate.The post-operative values of C2-C7 SVA,C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P =0.022,P <0.001,P =0.002).C2-C7 SVA increased to (23.0 ± 1.2) mm from pre-operative (20.7 ± 1.1) mm.C0-2 Cobb angle increased (23.1 ± 0.8) ° from pre-operative (19.9 ± 0.8) ° ; T1-Slope increased to (26.2 ± 0.7) ° from pre-operative (25.1 ± 0.7) °.The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively (Pearson =0.469,P < 0.001) (Pearson =0.303,P =0.004).Patients with higher preoperative T1-Slope had less JOA improvement(31.5% vs 53.7%,P =0.019)than those with lower preoperative T1-Slope after laminoplasty.Conclusion The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra.And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine.A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/70427
Appears in Collections:北京大学第三临床医学院_骨科_期刊论文

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作者单位: 100191,北京大学第三医院骨科

Recommended Citation:
林圣荣,周非非,孙宇,等. 颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化[J]. 中华医学杂志,2014,94(35):2726-2730.
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