结合K线分析颈椎后纵韧带骨化患者的颈椎活动度与手术预后的关系
摘要点击次数: 66   全文下载次数: 37   投稿时间:2018-01-02    
作者Author单位AddressE-Mail
王亚楠 WANG Ya-nan 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
谢梦琦 XIE Meng-qi 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
轩安武 XUAN An-wu 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
郭明明 GUO Ming-ming 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
李青松 LI Qing-song 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
马飞 MA Fei 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China  
王琪 WANG Qi 沈阳军区总医院骨科, 辽宁 沈阳, 110000 Department of Orthopaedics, the General Hospital of Shenyang Military, Shenyang 110000, Liaoning, China ven15@126.com 
期刊信息:《中国骨伤》2018年,第31卷,第8期,第763-768页
DOI:10.3969/j.issn.1003-0034.2018.08.015
基金项目:中国博士后科学基金面上项目(编号:2015M582821)
中文摘要:

目的:结合K线(颈椎侧位X线片上C2及C7椎管中点的连线)分析颈椎后纵韧带骨化患者的颈椎活动度与手术预后的关系。

方法:对2014年4月至2017年3月行颈椎后路单开门椎管扩大成形术的42例颈椎后纵韧带骨化(cervical ossification of the posterior longitudinal ligament,OPLL)患者进行回顾性分析。根据后纵韧带骨化与K线的位置关系,患者被分为K线(+)组及K线(-)组。后纵韧带骨化病灶未超过K线称为K线(+),反之,后纵韧带骨化病灶越过K线称为K线(-)。观察术前及术后3个月JOA (Japanese Orthopedic Association)评分,并计算术后3个月JOA改善率评估患者神经功能恢复情况。通过影像学资料测量术前及术后3个月后纵韧带骨化的侵占率(occupation ratio,OOR),颈椎生理曲度(cervical lordotic angles,CLA)和颈椎前凸值(cervical lordotic value,CLV)。评估不同的K线分组中,CLV>0组和CLV ≤ 0组之间患者的术后神经功能恢复之间的联系。

结果:K线(+)组和K线(-)组患者的术前CLA分别为(14.7±9.6)°和(-6.4°±9.5)(P<0.05),术后3个月分别为(14.0±8.0)°和(-1.4±10.4)°(P<0.05);术前JOA评分分别为10.9±3.2和11.2±2.5(P>0.05),术后3个月分别为14.2±1.8和12.6±2.2(P<0.05),术后3个月JOA改善率分别为(54.7±17.6)%和(25.5±15.7)%(P<0.05)。K线(+)组中,术后3个月CLV>0组的患者29例,其术后3个月JOA改善率(52.3±17.2)%,术后3个月CLV ≤ 0组的患者4例,其术后3个月JOA改善率为(72.2±7.8)%,术后3个月CLV ≤ 0组患者JOA改善率明显优于术后3个月CLV>0组(P<0.05)。

结论:无论患者颈椎后纵韧带骨化分类为K线(+)或K线(-),颈椎后路单开门椎管扩大成形手术都能够很好的改善患者的神经症状,尤其K线(+)组的患者,具有较好的预后效果。K线(+)组患者术后3个月CLV>0时,其JOA改善率较CLV ≤ 0的患者差。
【关键词】颈椎  后纵韧带骨化  K线  颈椎活动度
 
Combining K-line to analyse the relationship between cervical range of motion of patients with ossification of cervical posterior longitudinal ligament and surgical prognosis
ABSTRACT  

Objective:Combining K-line (the connecting line of the midpoint of C2 and C7 spinal canal on the cervical lateral X-ray film) to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament (OPLL) and surgical prognosis.

Methods:A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open-door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K-line (+) group and K-line (-) group according to the position realationship of OPLL and K-line. The lesion of ossification of the posterior longitudinal ligament was not over than the K-line known as K-line (+). Conversely,the lesion of ossification of the posterior longitudinal ligament crossing the K-line was called K-line (-). Preoperative and postoperative 3 months JOA scores were observed,and postoperative 3 months JOA improvement rate were computed to assess patient's neurological function recovery. Preoperation and postoperative 3 months,OPLL occupation ratio (OOR),cervical lordotic angles (CLA) and cervical lordotic value (CLV) were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV>0 group and CLV ≤ 0 group was evaluated in different K-line subgroups.

Results:For the patients in K (+) group and K (-) group,preoperative CLA were (14.7±9.6)° and (-6.4±9.5)°(P<0.05) respectively,postoperative at 3 months CLA were (14.0±8.0)° and (-1.4±10.4)°(P<0.05) respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5 (P>0.05) respectively,postoperative at 3 months JOA scores were 14.2±1.8 and 12.6±2.2 (P<0.05) respectively,and postoperative at 3 months JOA score improvement rate were (54.7±17.6)% and (25.5±15.7)%(P<0.05) respectively. In the K-line (+) group,there were 29 patients in CLV>0 group at 3 months after operation,with improvement rate of (52.3±17.2)%,and 4 patients in CLV ≤ 0 group,with improvement rate of (72.2±7.8)%. The improvement rate of the patients in CLV ≤ 0 group was significantly better than that of the patients in CLV>0 group (P<0.05).

Conclusion:No matter whether the ossification of cervical posterior longitudinal ligament was classified as K-line (+) or K-line (-),the cervical posterior single open-door laminoplasty can improve the neurological symptoms of patients,especially the patients in the K-line(+) group with better prognosis. The patinets in K-line(+) group,when postoperative at 3 months CLV>0,their improvement rate was lower than that of the patients with postoperative at 3 months CLV ≤ 0.
KEY WORDS  Cervical vertebrae  Ossification of posterior longitudinal ligament  K-line  Cervical range of motion
 
引用本文,请按以下格式著录参考文献:
中文格式:王亚楠,谢梦琦,轩安武,郭明明,李青松,马飞,王琪.结合K线分析颈椎后纵韧带骨化患者的颈椎活动度与手术预后的关系[J].中国骨伤,2018,31(8):763~768
英文格式:WANG Ya-nan,XIE Meng-qi,XUAN An-wu,GUO Ming-ming,LI Qing-song,MA Fei,WANG Qi.Combining K-line to analyse the relationship between cervical range of motion of patients with ossification of cervical posterior longitudinal ligament and surgical prognosis[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):763~768
查看  查看/发表评论  下载PDF阅读器
关闭

版权所有:《中国骨伤》杂志社京ICP备06016590号  版权声明
地址:北京市东直门内南小街甲16号,100700
电话:010-64089487 传真:010-64089792 Email:zggszz@sina.com