目的 探讨颈椎间盘突出症行前路椎间盘切除融合术(ACDF)中单间隙椎间高度(IH)与邻椎病后再手术的相关性。方法 选取2005-01至2020-11经手术治疗的颈椎间盘突出症68例,ACDF术后3 d测量IH,根据数值分为4组:术前中立位IH的130%～140%(A组),141%～150%(B组),151%～160%(C组)及161%～170%(D组),随访观察:IH与手术节段(Cn)Cobb改善角度、C2-7Cobb改善角度、胸廓入口角(TIA)及胸1倾斜角(T1S)间的关系;发生邻椎病后上、下相邻节段IH的变化;不同IH对邻椎病后再手术的影响。结果 B组发生邻椎病后再手术率最低(7%),与B组比较,A组、C组、D组邻近节段IH下降显著,差异有统计学意义(P<0.05)。相关分析显示,椎间高度的增加值(ΔIH),与手术节段Cobb角度变化呈弱相关(r=0.426, P=0.028),与C2-7Cobb的变化值、TIA及T1S无显著相关性。C、D组中邻椎病再手术数占再手术总数71.4%。结论 术后单间隙IH大于术前IH的150%是发生邻椎病再手术的高危因素,单间隙IH达术前140%～150%,发生邻椎病最少,是较理想的IH。
Abstract
Objective To investigate the correlation between intervertebral height (IH) during anterior discectomy and fusion (ACDF) for cervical disc herniation and reoperation after adjacent segment disease (ASD). Methods A total of 68 cases of cervical disc herniation treated by operation in Jiangsu Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2005 to November 2020 were selected. IH was measured 3 days after ACDF operation and divided into 4 groups according to the value. Preoperative neutral IH was, 130%-140% (group A), 141%-150% (group B), 151%-160% (group C), and 161%-170% (group D). Follow-up observation was conducted to observe three aspects, the relationship between IH and Cobb improvement angle of operative segment (Cn), C2-7Cobb improvement angle, thoracic inlet angle (TIA) and T1 slope (T1S), the IH changes in the upper and lower adjacent segments after ASD, and the effect of different IH on reoperation after ASD. Results The rate of reoperation after ASD in group B was the lowest (7%). Compared with group B, IH in adjacent segments of groups A, C and D significantly decreased (P<0.05), and the difference was statistically significant (P<0.05). Correlation analysis showed that intervertebral height increment (ΔIH) was weakly correlated with the Cobb improvement angle of operative segment (Cn) (r=0.426, P=0.028), but not significantly correlated with the change of C2-7Cobb, TIA or T1S. In group C and group D, the number of reoperation for adjacent segment disease accounted for 71.4% of the total number of reoperations. Conclusions Single gap IH greater than 150% before operation is a high risk factor for the reoperation for ASD. The 140%~150% group is characterized by the least ASD, which is a relatively ideal IH.
关键词
颈椎 /
前路椎间盘切除融合术 /
单间隙 /
椎间高度 /
邻椎病
Key words
cervical vertebra /
anterior cervical discectomy and fusion /
single gap /
intervertebral height /
adjacent segment degeneration
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