椎体次全切除术与椎管扩大椎板成形术术后颈椎矢状位平衡的对比研究

目的对比分析椎体次全切除植骨融合术与椎管扩大椎板成形术术后颈椎矢状位平衡的变化。方法收集2010年2月—2013年1月本院收治的100例因脊髓性颈椎病伴椎管狭窄症并接受颈椎椎体次全切除植骨融合术(前路组,n=53)或颈椎椎管扩大椎板成形术(后路组,n=47)患者的临床及影像学资料,通过对比术前及末次随访时日本骨科学会(JOA)评分、C_(2~7) Cobb角、矢状面轴向垂直距离(SVA)、T_1倾斜角(T_1-slope)的变化,分析不同术式术后患者矢状位平衡的变化。结果所有手术均顺利完成,随访(25.5±3.2)个月。2组患者术前JOA评分、C_(2~7) Cobb角、SVA、T_1-slope差异无统计学意义(P0.05)。末次随访时JOA评分、C_(2~7) Cobb角、SVA均较术前明显改善,且组间差异有统计学意义(P0.05);前路组中,术前高T_1-slope患者与低T_1-slope患者术后颈椎后凸发生率差异无统计学意义(P0.05);后路组中,高T_1-slope患者颈椎后凸发生率显著高于低T_1-slope患者,差异有统计学意义(P0.05)。结论颈椎前路椎体次全切除术对术后颈椎矢状位平衡的影响优于颈椎后路椎管扩大椎板成形术;当术前患者T1-slope较高时,为减少术后矢状位平衡失代偿,可尽量选择前路手术。

Comparison of cervical sagittal balance after anterior cervical corpectomy and laminoplasty

Objective To compare the sagittal balance parameters following the procedures of anterior cervical corpectomy and fusion(ACCF) and posterior laminoplasty. Methods Clinical and radiographical data of 100 patients who underwent ACCF(anterior group,n=53) or laminoplasty(posterior group,n=47) from February 2010 to January 2013 were reviewed retrospectively. The pre-and postoperative Japanese Orthopaedic Association(JOA) score,C_2-7 Cobb''s angles,sagittal vertical axis(SVA) and T₁-slope were recorded respectively,and were used to analyzed the postoperative sagittal balance. Results All the operations were successfully completed. The follow-up period was (25.5±3.2)months. There was no significant difference in pre-operative JOA score,C_2-7 Cobb''s angle,SVA and T₁-slope between anterior and posterior groups. At the final follow-up,JOA score,C_2-7 Cobb''s angles and SVA were significantly improved,and the differences were statistically significant between the 2 groups(P < 0.05). In anterior group,no significant difference in postoperative kyphosis rate was noted between the high T₁-slope group and low T₁-slope group. In posterior group,a higher rate of kyphosis was observed in high T₁-slope group(P < 0.05). Conclusion ACCF is an optimal option for maintaining cervical sagittal balance compared with laminoplasty. In patients with high T₁-slope,ACCF should be suggested to avoid postoperative sagittal imbalance.