单节段颈椎间盘置换术中颈椎体位对术后颈椎中立位 生理轴线

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Chinese Journal of Reparative and Reconstructive Surgery, January 2013, Vol. 27, No.1
单节段颈椎间盘置换术中颈椎体位对术后颈椎中立位 生理轴线重建的影响
洪瑛 1 邓宇骁 2 刘浩 2 龚仁蓉 1 安晶晶 1 龚全 2 李涛 2 宋跃明 2
【Abstract】 Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P < 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t=—0.391, P=0.698), and between the targeted disc and the cervical al ignment (t=—1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical al ignment (t=—2.623, P=0.012).
1 临床资料 1.1 患者选择标准
纳入标准：① CDR 患者；② C2 ～ 7 单节段椎间盘 置换；③采用 PRESTIGE LP 椎间盘假体（Medtronic 公 司，美国）；④术前、术中及术后影像学资料完整。排除 标准：CDR 合并 ACDF。共 51 例患者符合选择标准， 纳入研究。 1.2 一般资料
【Key words】 Cervical disc replacement Posture Cobb angle Cervical curve restoration
经 前 路 颈 椎 间 盘 切 除 融 合 内 固 定 术（anterior cervical discectomy and fusion，ACDF）由 Smith 等 [1] 提出后，经过数十年的发展，目前已是前路手术治疗 颈椎病的经典术式。但近年来多项研究表明，ACDF 存在颈椎活动受限 [2]、邻近节段退变 [3-4] 等远期并发 症。 由 此，近 十 年 来 颈 椎 间 盘 置 换 术（cervical disc replacement，CDR）的发展取得了长足进步。然而在 CDR 术中颈椎体位方面仍存在分歧。虽然有不少学 者 [5-7] 认为术中颈椎维持生理性中立位有利于术后颈 椎恢复生理轴线，但仍有部分术者 [8] 在术中采用使 颈椎生理前凸消失、颈椎呈直线的方式以保持目标椎 间隙的终板平行；并且有研究提示 [6，9]，颈椎病患者 的颈椎中立位在术前已发生变化，不再维持在生理中 立位。目前罕有关于 CDR 术中颈椎体位的研究。本 研 究 回 顾 性 分 析 2008 年 1 月 － 2010 年 8 月 我 院 行 CDR 手 术患者的临床资料，探讨 CDR 术中颈椎体位 对 术后早期颈椎中立位生理轴线重建的影理轴线重建
INFLUENCE OF INTRAOPERATIVE CERVICAL POSTURE IN SINGLE SEGMENTAL CERVICAL DISC REPLACEMENT ON RESTORATION OF CERVICAL CURVE IN NEUTRAL POSITION/HONG Ying1, DENG Yuxiao2, LIU Hao2, GONG Renrong1, AN Jingjing1, GONG Quan2, LI Tao2, SONG Yueming2. 1Operation Room, 2Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: LIU Hao, E-mail: liuhao6304@; GONG Renrong, E-mail: gongrenrong@
中国修复重建外科杂志2013年1月第27卷第1期
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The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P < 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.
【摘 要】 目的 探讨颈椎间盘置换术（cervical disc replacement，CDR）术中体位与术后早期颈椎中立位生理轴 线重建的相关性。 方法 回顾性分析 2008 年 1 月－ 2010 年 8 月 51 例采用 PRESTIGE LP 椎间盘假体行单节段 CDR 患者的临床资料，术中患者取仰卧位，颈枕置于颈后部维持颈椎前弓。男 28 例，女 23 例；年龄 30 ～ 64 岁，平均 45 岁。 其中脊髓型颈椎病 32 例，神经根型颈椎病 7 例，混合型颈椎病 12 例。病程 3 ～ 48 个月，平均 15 个月。手术节段：C4、5 5 例，C5、6 42 例，C6、7 4 例。收集患者术前、术中及术后 3 个月颈椎中立位、侧位 X 线片，分别测量颈椎整体序列（C2 ～ 7）、 目标脊柱功能单位（functional spinal unit，FSU）及目标椎间隙的 Cobb 角。计算术中与术前的角度差（差值）及术后早期 （3 个月）与术前的角度差（改善值），对不同平面 Cobb 角差值和改善值进行线性相关及线性回归分析。 结果 与术前 相比，术中及术后 3 个月时颈椎 Cobb 角均显著增大（P < 0.05）。其中颈椎整体序列、目标 FSU 及目标椎间隙的 Cobb 角 差值分别为（6.72 ± 9.13）、（2.10 ± 5.12）、（3.33 ± 3.75）°；术后 3 个月 Cobb 角的改善值分别为（6.30 ± 7.28）、（3.99 ± 5.37）、 （4.29 ± 5.36）°。目标 FSU 的 Cobb 角改善值与目标椎间隙 Cobb 角改善值比较差异无统计学意义（t= —0.391，P=0.698）， 与颈椎整体序列 Cobb 角改善值比较差异有统计学意义（t= —2.623，P=0.012）；目标椎间隙角度改善与整体序列角度改善 比较差异无统计学意义（t= —1.917，P=0.061）。颈椎整体序列、目标 FSU、目标椎间隙的术中颈椎 Cobb 角差值与术后早期 颈椎 Cobb 角改善值 3 对变量之间均存在线性相关及线性回归关系（P < 0.05）。 结论 CDR 术中颈椎位置保持在较术 前中立位轻度后伸的位置是术后早期颈椎维持正常生理前凸的一个重要因素。