颈椎前路椎间盘切除融合术对颈椎矢状面平衡改变和疗效分析

目的：研究颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）对颈椎矢状面参数的影响及临床疗效；不同节段个数ACDF手术之间的差异。方法：回顾性分析2013年2月—2016年1月在南京医科大学第一附属医院行ACDF手术的52例颈椎间盘突出症患者。在MRI上测量手术前后的颈椎矢状面参数，包括C0C2角、C2C7角、T1倾斜角、颈倾角和胸廓入口角。临床疗效通过疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科学会(Japanese Orthopaedic Association Scores,JOA)评分进行评估,对所得结果进行统计学分析。结果：术后C2C7角、T1倾斜角较术前增大，颈倾角较术前减小（P<0.05），术后VAS与JOA评分较术前均明显改善（P<0.05）;单节段、双节段和多节段手术在手术时间、出血量上存在差异（P=0.001），在颈椎矢状位参数手术前后的差值以及治疗改善率上三者之间无明显差异。结论：颈椎前路椎间盘切除融合术治疗颈椎病疗效确切，手术通过改变颈椎曲度、增大T1倾斜角来恢复颈椎矢状位的平衡，不同节段个数的颈椎手术，在颈椎矢状位参数的改变和治疗改善率上无明显差异。

Evaluation of anterion cervical discectomy and fusion on sagittal balance of cervical spine

Objective: To evaluate clinical results and changes in cervic sagittal parameters after anterior cervical discectomy and fusion (ACDF) and to analyze the difference on clinical prognoses among treatment of different surgical segments. Methods: A retrospective study was performed in 52 cases of cervical disc herniation from February 2013 to January 2016 in the First Affiliated Hospital of Nanjing Medical University, who were undertaken by ACDF. Before and after the operations, cervical sagittal parameters were measured in MRI, including C0C2 angle, C2C7 angle, T1 slope, neck tilting and thoracic inlet angle. Therapeutic effects were evaluated by pain visual analogue scale (VAS) and Japanese Orthopaedic Association Scores (JOA). Results: The C2C7 angle and T1 slope were increased with the decreased neck tilting postoperatively. Also,the scores of VAS and JOA were improved after ACDF with a significant difference (P<0.05). Compared preoperative and postoperative results among single-level segment, double-levels segments and multiple-levels segments treatment, there were significant differences in the duration of operation and the amount of bleeding (P value =0.001). However, no statistical difference was found in cervical sagittal parameters changes and clinical improvement rate. Conclusion: Anterior cervical discectomy and fusion for cervical spondylosis comes out with a good therapeutic effect, which could improve the cervical curvature and increase the T1 slope to restore cervical sagittal balance. No significant difference was found in the changes of cervical sagittal parameters for different segements as well as clinical prognoses postoperatively in the treatment of cervical disc herniation.