目的 探讨多节段脊髓型颈椎病(cervical stenotic myelopathy,CSM)患者行颈椎管后路单开门扩大成形术后,影响术后颈肩轴性痛(postoperative axial pain,PAP)病程长短的相关危险因素。方法 回顾性分析2007-02至2010-02,武警后勤学院附属医院和天津市天津医院因颈椎管狭窄行后路单开门扩大成形减压,联合连续节段开门侧Centerpiece微型板钉固定患者344例,其中出现32例PAP患者,平均随访3年以上,根据PAP持续时间,将患者分为2~5个月较快和6~16个月内较慢恢复组,比较PAP两组术后6个月门轴侧骨槽融合率,日本矫形骨科学会(Japanese orthopaedic association score, JOA)增长率、末次随访较首发PAP疼痛(visual analogue score,VAS)和颈椎功能障碍指数(neck disability index,NDI)矫正值,术后即刻较术前颈椎屈伸度、曲度和椎管矢径矫正值,多元逻辑回归分析患者术前颈椎曲度、椎管矢径、颈椎屈伸度和术后门轴侧骨槽融合率对PAP持续时间的影响。结果 32例PAP患者均经非手术治疗,其中21例PAP术后2.8~4.8个月缓解,11例PAP术后6.9~15.5个月恢复,PAP较快改善组骨槽融合率高于较慢恢复者,差异有统计学意义(Z=2.18,P=0.04),门轴侧骨槽融合率系预测PAP病程长短的危险因素(OR=4.9619,P=0.0465)。结论 门轴侧骨槽愈合率显著提高并获尽早确切融合,有助于缩短颈椎管后路单开门扩大成形术后PAP恢复进程。
Abstract
Objective To investigate the risk factors for predicting the duration of postoperative axial pain(PAP) for multi-level cervical stenosis myelopathy(CSM) treated by unilateral laminoplasty fixed with centerpiece mini-plates. Methods Clinical data about a total of 344 patients with CSM who had undergone the above-mentioned laminoplasty was retrospectively analyzed after a minimum of three years of follow-up. The participants were classified into the fast recovery group (2 to 5 months) and slow recovery group (6 to 16 months) according to the duration of PAP. The differences in the bony fusion rate on the hinge side and JOA improvement rate at postoperative 6 months, the correction value of the Visual Analogue Score and Neck Disability Index during the final follow-up compared with the initial onset, and the correction value of the range of motion, static alignment, mid-sagittal diameter of cervical canal immediately after operation in contrast to preoperative conditions were compared between the two groups. Multivariate logistic regression analysis was used to verify the association between the preoperative Cobb angle, canal sagittal diameter at the maximally compressed level, range of motion,fusion rate and PAP development. Results All the 32 cases with PAP got relieved after the conservative treatment, 21 of whom were relieved within 2.8 to 4.8 months, and the rest within 6.9 to 15.5 months. The fusion rate on the hinge side at postoperative 6 months in the fast recovery group was higher than that in the slow recovery group, and the difference was of statistical significance(Z=2.18,P=0.04). Fusion rate was the only independent factor for predicting the duration of PAP(OR=4.9619,P=0.0465). Conclusions Fast and reliable fusion of bones on the hinge side after unilateral laminoplasty can help shorten the duration of PAP.
关键词
术后轴性痛 /
单开门成形 /
脊髓型颈椎病 /
门轴侧骨槽融合率 /
持续时间 /
棘突韧带复合体
Key words
postoperative axial pain /
unilateral laminoplasty /
cervical stenosis myelopathy /
fusion rate of hinge-side groove /
duration /
posterior ligament complex
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基金
武警后勤学院博士启动金(WYB201109); 天津市自然科学基金(043609011:短束纤维受压诱发神经根型颈椎病的实验研究)
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