颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术后早期颈椎矢状面平衡的变化

【摘要】 目的：探讨颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的早期临床疗效。方法：回顾性分析2013年8月~2020年9月我院采用颈后路椎管扩大椎板成形术治疗的75例多节段CSM患者，其中42例患者采用颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术（升顶组），年龄31~79岁（57.2±10.7岁）；33例患者采用传统“关节囊悬吊法”单开门椎管扩大椎板成形术（悬吊法组），年龄48~82岁（67.2±9.6岁）。所有患者于术后3～14个月门诊随访。收集两组患者的住院相关基本信息；在术前和末次随访时的颈椎X线片上测量颈椎矢状面平衡参数，包括C0-2 Cobb角、C2-7 Cobb角、C2-7矢状面轴向距离（C2-7 SVA）、C7倾斜角（C7-Slope），同时测量颈椎活动度（ROM）；术前和末次随访时采用改良JOA（mJOA）评分、VAS评分和颈椎功能障碍指数（NDI）评估，计算mJOA评分改善率。结果：两组患者性别、术中出血量和平均随访时间差异无统计学意义（P>0.05）。升顶组患者年龄和术后住院天数均小于悬吊法组（P<0.05）。两组术前C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA、C7-Slope和颈椎ROM均无统计学差异（P>0.05），末次随访时升顶组C7-Slope和C2-C7 SVA小于悬吊法组（P<0.05），C2-7 ROM大于悬吊法组（P<0.05）。两组末次随访时mJOA和VAS评分与术前比较均有明显改善，差异有统计学意义（P<0.05）；两组间同时间点mJOA和VAS评分比较无统计学差异（P>0.05），mJOA评分改善率亦无统计学差异（P>0.05）。两组末次随访时NDI与术前比较无统计学差异（P>0.05），两组间同时间点比较亦无统计学差异（P>0.05）。结论：与传统颈后路单开门椎管扩大椎板成形术相比，颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段CSM早期可获得相同神经功能改善效果，且在维持颈椎矢状面平衡及颈椎活动度方面更具优势。     

Development and validation of a novel thoracic spinal stenosis surgical invasiveness index: a single-center study based on 989 patients

Background contextSurgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed.PurposeTo develop and validate a novel invasiveness index, incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk.Study designA retrospective observational study.Patient sampleOverall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included.Outcome measuresThe operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses.MethodsWe retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n=692) were randomly placed in a training cohort, and the remaining 30% (n=297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort.ResultsThe TII was more strongly correlated with operative time and estimated blood loss (p<.05) and explained more variability in operative time and estimated blood loss than the SII (p<.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (p<.05).ConclusionsBy incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.