前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响

摘要

目的 探讨前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响.方法 2011年1月—2016年9月在本院行前路颈椎椎间盘切除融合术(ACDF)及前路颈椎椎体次全切除融合术(ACCF)治疗的颈椎椎间盘突出症患者159例,男79例,女80例;年龄(51.85±9.60)岁.在MRI上测量颈椎矢状位参数,包括C2~7 Cobb角、T1倾斜角(T1SA)、颈倾角(NTA)和胸廓入口角(TIA),采用配对t检验比较手术前后各参数的差异.根据T1SA大小分为低T1SA组(T1SA≤20°,53例)、中T1SA组(20°30°,25例),采用 χ2检验比较不同T1SA组间各个节段退变率的差异.结果 术后C2~7 Cobb角、T1SA和NTA的测量结果与术前相比,差异有统计学意义(P<0.05),TIA与术前相比,差异无统计学意义.159例病例中病变共累及311个节段,其中C5/C6最多,为102个;C4/C5次之,为91个.C3/C4、C4/C5、C5/C6和C6/C7退变率在不同T1SA组之间差异有统计学意义(P<0.05),随着T1SA增加,C3/C4和C4/C5退变率逐渐增加,C5/C6和C6/C7退变率逐渐降低.结论 前路手术可能通过增加颈椎椎间盘突出症患者C2~7 Cobb角进而增加T1SA,从而更有力地维持颈椎生理曲度;随着T1SA的增加,退变节段有由下往上发展的趋势.%Objective To analyze the influence of anterior cervical spine surgery on cervical sagittal parameters in patients with cervical disc herniation. Methods From January 2011 and September 2016,159 patients with cervical disc herniation who underwent anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) were retrospectively studied. The study included 79 males and 80 females,whose age was (51.85±9.60) years old. The cervical sagittal parameters were measured on MRI,including C2-7 Cobb's angle,T1 slope angle(T1SA),neck tilting angle(NTA) and thoracic inlet angle(TIA),and the data were analyzed by paired samples t test between pre- and post-operation. According to preoperative T1SA,the patients were divided into low T1SA group(T1SA ≤20°,53 cases),normal T1SA group(20° 30°,25 cases),and the degeneration rates were analyzed by chi-square test between different T1SA groups. Results Postoperative C2-7 Cobb's angle,T1SA and NTA showed statistically significant difference(P<0.05) compared with the preoperative data,but TIA showed no significant difference(P>0.05). Of the 159 patients,a total of 311 segments were identified as degeneration,with C5/C6 being 102,which was the most maximum and C4/C5 being 91,taking the second place. The differences in degeneration rates of C3/C4,C4/C5,C5/C6 and C6/C7 were statistically significant between the different T1SA groups(P < 0.05). With the increase of T1SA,the degeneration rate of C3/C4 and C4/C5 increased and that of C5/C6 and C6/C7 decreased gradually. Conclusion Anterior cervical spine surgery may increase the C2-7 Cobb's angle and then increase the T1SA in patients with cervical disc herniation,thereby more effectively maintaining the lordosis of the cervical spine;with the increase of T1SA,the degenerated segment has a tendency to develop from lower level to higher level.