颈椎前路钢板位置与术后颈肩痛的相关性研究

目的:观察颈椎前路钢板内固定术后颈肩痛与钢板位置之间的关系。方法:回顾分析1999年8月～2006年7月间实施的219例颈椎前路钢板内固定手术的临床和影像学资料。颈椎侧位片评价钢板在上下位椎体的覆盖率,正位片评估其侧方移位和成角;应用视觉模拟评分(VAS)、颈椎活动障碍指数(neck disability index,NDI)评价手术前、后颈肩痛。应用Pearson’s相关系数、线性回归分析进行统计学分析。结果:平均随访16.8个月(6～42个月),钢板侧方偏移和成角与术后颈肩痛高度相关(相关系数P=0.417,P<0.001,n=87),线性回归分析显示钢板偏移和成角与术后VAS评分高度正相关(相关系数P=0.314,P<0.001,n=82),与术后NDI成正相关(相关系数P=0.379,P<0.001,n=66)。结论:颈椎前路钢板侧方偏移和成角是术后颈肩痛的原因之一,术中应注意调整钢板位置,尽量避免侧方偏移和成角。

Relationship between the position of cervical anterior plate and postoperative neck pain

Objective: To explore the relationship between plate position and neck pain after anterior cervical discectomy and fusion(ACDF). Methods: Clinical and radiographic data of 219 cases were reviewed retrospectively. Pre-and post-operation VAS and neck disability index (NDI) were used for evaluation of neck and arm pain. Plate position was measured as percentage coverage of superior and inferior vertebral body on the lateral view as well as angulation and lateral displacement on the anteroposterior view of X-ray films. Pearson's correlation coefficient and linear regression analysis were used statistically for radiographic and clinical results. Results: The time of mean follow-up in this group was about 16.8 months. There was a significant association between lateral plate position or plate angulation and postoperative neck pain(Pearson's coeff. P=0.417,P<0.001). Linear regression analysis confirmed a strong correlation between plate angulation or lateral deviation from midline and VAS(corr. coeff, P=0.314,P<0.001,n=82), and higher rate postoperative NDI(corr. coeff, P=0.379,P<0.001,n=66). Conclusions: Lateral plate deviation and angulation from midline was the significant risk factors associated with postoperative neck pain. Plate position should be noticed and corrected during operation to avoid deviation from midline.