侧块螺钉固定术后颈椎曲度与脊髓漂移距离的关系及对临床疗效的影响

目的 观察全椎板减压侧块螺钉固定术后颈椎曲度改变与脊髓漂移距离及对临床疗效的影响。方法 2017年1月至2018年10月,117例脊髓型颈椎病患者,均接受全椎板减压侧块螺钉固定术治疗,其中90例完成随访。术后根据患者颈椎曲度大小分组。A组(n= 28)颈椎曲度变直(颈椎角0°~5°),B组(n= 36)颈椎曲度变小(颈椎角5°~16.5°),C组(n = 26)颈椎曲度正常(颈椎角 > 16.5°)。术后观察三组脊髓漂移距离、神经恢复情况、轴性症状和C ₅神经麻痹发生情况。结果 三组间术后颈椎角和脊髓漂移距离有非常高度显著性差异(F > 152.119, P < 0.001),椎板切除宽度和C ₅神经麻痹发生率无显著性差异(P > 0.05)。术后3个月和末次随访时,三组日本矫形外科协会(JOA)评分均显著升高( t > 8.869, P < 0.001),组间比较均无显著性差异( P > 0.05)。三组神经功能恢复率无显著性差异( F = 0.472, P = 0.625)。术后3 d和1个月,三组间轴性症状VAS评分比较均有非常高度显著性差异(F > 34.800, P < 0.001),B组和C组显著低于A组( t > 5.845, P< 0.001),B组和C组间无显著性差异(t < 1.765, P > 0.05)。 结论 在椎板切除宽度相同的基础上,颈椎曲度越大越有利于脊髓向后漂移,颈椎曲度过度丢失与轴性症状的发生有关,与神经功能恢复和C₅神经麻痹无明显关联。

Relationship between Cervical Curvature and Spinal Drift Distance after Laminectomy with Screw Fixation and Its Effect on Clinical Outcome

Objective To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation,and its effect on clinical outcome.Methods From January,2017 to October,2018,a total of 117 patients with cervical spondylotic myelopathy(CSM)underwent laminectomy with lateral mass screw fixation,and 90 of them completed the follow-up.According to the patients’cervical curvature(CC),they were divided into three groups:those CC between 0°to 5°were in Group A(n=28),5°to 16.5°in Group B(n=36)and CC>16.5°in Group C(n=26).The spinal drift distance,nerve recovery,axial symptoms and C5 palsy were recorded and analyzed.Results There were significant differences in CC and spinal drift distance(F>152.119,P<0.001),and no significant difference was found in laminectomy width and incidence of C5 palsy(P>0.05)among three groups.The Japanese Orthopaedic Association(JOA)score significantly increased in all the groups post operation and at the last follow-up(t>8.869,P<0.001),and no significant difference was found among there groups at the same time(P>0.05),as well as the incidence of C5 palsy(F=0.472,P=0.625).There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups(F>34.800,P<0.001),which was lower in groups B and C than in group A(t>5.845,P<0.001),and no significant differene was found between group B and group C.Conclusion On the basis of the same laminectomy width,the greater the CC was,the more favorable the spinal drift went backwards.The loss of CC was related to the occurrence of axial symptoms,but was not correlated with the neurological recovery and C5 palsy.