| 颈椎椎体次全切除后施术椎的前移现象及临床意义 |
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Received:April 24, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 谢建新 |
XIE Jian-xin |
浙江大学附属第二医院骨科, 浙江 杭州 310009 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China |
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| 陈其昕 |
CHEN Qi-xin |
浙江大学附属第二医院骨科, 浙江 杭州 310009 |
Department of Orthopaedics, the 2nd Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年29卷，第10期，第947-953页 |
| DOI：10.3969/j.issn.1003-0034.2016.10.014 |
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目的：探讨颈椎椎体次全切除后施术椎的前移现象和临床意义。
方法：回顾性分析2010年1月至2013年4月收治的164例脊髓型颈椎病患者资料，男88例，女76例；年龄38~74岁，平均56.2岁；颈前路C4椎体次全切除术31例，C5椎体次全切除术87例，C6椎体次全切除术46例。CT矢状位分别测量手术前后施术椎椎管后壁与相邻上椎体前上缘和下椎体前下缘连线的直线距离，计算两者的差值，以评估施术椎发生前移的程度。运用快速聚类法，将施术椎的移位距离作为变量，根据前移距离的大小，90例归为前移距离较大组，74例归为前移距离较小组。对施术椎前移与颈椎术后曲度改变及施术节段的关系进行分析；术前及术后1周、术后6个月、末次随访时采用日本骨科学会（Japanese Orthopaedic Association，JOA）评分，观察患者改善率，并对施术椎前移与椎管对角线直径和临床疗效的关系进行分析。
结果：164例患者均获随访，时间12~48个月，平均29.5个月。施术椎与术前比较均有不同程度前移，其中最大值3.52 mm，最小值1.12 mm，平均（2.14±1.02） mm。根据聚类结果，前移平均距离（3.07±0.21） mm归为在前移距离较大组（90例，54.9%）；前移平均距离（1.55±0.32） mm归为前移距离较小组（74例，45.1%）；施术椎前移与各施术节段差异无统计学意义（χ2=0.01，P=0.996）；施术椎的前移距离与颈椎曲度指数存在正相关性（r=0.724）；前移距离较大组的颈椎管对角线径减少发生率高于前移距离较小组（χ2=4.45，P=0.035）；疗效不满意组中出现施术椎前移距离较大患者的发生率也明显高于疗效满意组（P<0.05）。
结论：颈椎前路椎体次全切除术后可出现施术椎不同程度前移，明显前移可能造成脊髓的再压迫，影响手术疗效。 |
| [关键词]:脊髓型颈椎病 前路减压 脊柱融合 外科手术 |
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| Anterior slip phenomenon of the vertebrae after corpectomy surgery and its clinical significance |
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Abstract:
Objective:To investigate the anterior slip phenomenon of the vertebrae after corpectomy surgery and its clinical significance.
Methods:The clinical data of 164 patients with cervical spondylotic myelopathy treated from January 2010 to April 2013 were retrospectively analyzed. There were 88 males and 76 females,aged from 38 to 74 years old with the mean of 56.2 years. Among them,31 cases for C4 corpectomy,87 cases for C5 corpectomy,46 cases for C6 corpectomy. Preoperative and postoperative distance of posterior wall of vertebral canal to the line of adjacent upper vertebral bodies anterosuperior border and lower vertebral bodies anteroinferior border was measured by CT in cervical sagittal middle layer scanning as the center,anterior slip degree of the vertebrae after operation was evaluated. The fast clustering method was used,the vertebral shift distance as variable,according to the size of the forward distance,90 cases classified as group 1(forward greatly group),and the 74 cases classified as group 2(forwad short group). The relationships on the anterior slip of the vertebrae and cervical curvature,surgical segment were analyzed. Japanese Orthopaedic Association (JOA) scores and its improvement rate were observed before and after operation,and the relationships on the anterior slip of the vertebrae and sagittal plane diagonal diameter of spinal canal,clinical effect were analyzed.
Results:All the patients were followed up from 12 to 48 months with an average of 29.5 months. All operative vertebrae occurred anterior slip with different degree after corpectomy surgery,the maximum was 3.52 mm and minimum was 1.12 mm,with an average of (2.14±1.02) mm. According to the clustering method,the anterior slip distance with (3.07±0.21) mm classified as forward greatly group(90 cases,54.9%) and the anterior slip distance with (1.55±0.32) mm classified as forwad short group(74 cases,45.1%). There was no significant difference between anterior slip distance and operation segments(χ2=0.01,P=0.996). Cervical curvature index and anterior slip distance of operated vertebra had a positive correlation (r=0.724). The incidence of reduction of the diagonal diameter of cervical spinal canal in forward greatly group was higher than that of forwad short group(χ2=4.45,P=0.035). The patients with unsatisfactory efficacy appeared obvious anterior slip of the vertebrae after corpectomy than the patients with satisfactory efficacy(P<0.05).
Conclusion:Corpectomy of the cervical spine can result in vertebral forward displacement trend,and obvious displacement may cause the secondary compression of the spinal cord. |
| KEYWORDS:Cervical spondylotic myelopathy Anterior decompression Spinal fusion Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 谢建新,陈其昕.颈椎椎体次全切除后施术椎的前移现象及临床意义[J].中国骨伤,2016,29(10):947~953 |
| 英文格式: | XIE Jian-xin,CHEN Qi-xin.Anterior slip phenomenon of the vertebrae after corpectomy surgery and its clinical significance[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(10):947~953 |
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