颈椎前路椎间盘切除融合术术中恢复椎间隙自然高度对术后疗效的影响

目的探讨颈椎前路椎间盘切除融合术(ACDF)融合节段的椎间隙高度与术后疗效的关系。方法测量100例健康志愿者颈椎各椎间隙高度,计算各椎间隙高度与C2/C3椎间隙高度比值作为参考标准。回顾性分析2013年1月—2016年6月行ACDF治疗的139例颈椎病患者临床资料。根据手术节段术后椎间高度与C2/C3椎间高度比值是否在参考值95%可信区间内分为自然高度组和非自然高度组。术前及末次随访时采用日本骨科学会(JOA)评分评估神经系统功能,采用疼痛视觉模拟量表(VAS)评分评估疼痛情况。末次随访统计并分析轴性症状发生情况。结果末次随访时2组JOA评分均较术前明显提高,差异有统计学意义(P 0.05),但2组间比较差异无统计学意义(P 0.05);末次随访时2组VAS评分均较术前明显下降,且自然高度组较非自然高度组下降更明显,差异均有统计学意义(P 0.05)。自然高度组轴性症状发生率为15.4%,非自然高度组为35.1%,差异均有统计学意义(P 0.05)。结论 ACDF术中椎间隙的撑开高度应参照自身其他健康椎间隙的高度,控制手术节段的椎间隙高度与健康椎间隙高度比值在95%可信区间内,椎间隙高度过高或过低均会导致术后轴性症状发生率增加。

Effect of restoration of natural height of intervertebral space on postoperative outcome during anterior cervical discectomy and fusion

Objective To investigate the relationship between the height of the intervertebral space and the therapeutic effect of anterior cervical discectomy and fusion(ACDF). Methods The height of cervical intervertebral space of 100 healthy volunteers were measured,then the ratios of the heights of the cervical intervertebral spaces to C₂/C₃ intervertebral space height were calculated,as a reference standard. The clinical data of 139 patients with cervical spondylopathy treated with ACDF from January 2013 to June 2016 were retrospectively analyzed. The cases were divided into natural height group and unnatural height group according to the ratio of fused segments'' intervertebral height to C₂/C₃ intervertebral height was or was not in the range of 95% confidence interval(CI). The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) score were used to evaluate pre-and post-operative neurological function and pain. Statistical analysis of axial symptoms was made at the final follow-up. Results The JOA scores of the 2 groups at the final follow-up were significantly higher than pre-operation,but there was no statistical difference between the 2 groups(P>0.05). At the final follow-up,the VAS scores of both groups were significantly lower than pre-operation. Compared with the unnatural height group,the VAS score of the natural group was significantly lower,and the difference was statistically significant(P<0.05). The incidence of axial abnormality was 15.4% in natural height group,and it was significantly lower than that in unnatural height group(35.1%),and the difference was statistically significant(P<0.05). Conclusion The height of the intervertebral space in ACDF should be referred to the height of the other healthy intervertebral space. The ratio of the height of the operated intervertebral space to the height of the healthy intervertebral space should be controlled within the 95% CI. A too high or too low intervertebral space will lead to an increase in the incidence of axial symptoms.