摘要
目的探究术前症状持续时间对神经根型颈椎病(cervical spondylotic radiculopathy,CSR)患者行人工颈椎间盘置换术(cervical disc arthroplasty,CDA)后疗效的影响。方法回顾性分析2008年1月—2020年3月行单节段CDA且符合选择标准的90例CSR患者临床资料,根据术前症状持续时间分为早期干预组(59例,术前症状持续时间<24个月)和晚期干预组(31例,术前症状持续时间≥24个月)。两组患者年龄、性别、身体质量指数、吸烟状况、手术节段及术前颈部功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、颈椎曲度(cervical lordosis,CL)、C2~C7活动度(range of motion,ROM)、置换节段角(disc angle,DA)、置换节段ROM(disc ROM,DROM)、置换节段间隙高度(disc intervertebral height,DIH)等基线资料比较差异均无统计学意义(P>0.05);术前早期干预组日本骨科协会(JOA)评分略高于晚期干预组(P<0.05)。记录并比较两组手术时间、术中出血量、术后住院时间等围术期指标;采用末次随访时JOA评分、NDI及VAS评分较术前的变化值评价临床疗效,采用术前、术后即刻及末次随访时的CL、C2~C7 ROM、DA、DROM、DIH进行影像学评估;末次随访时,评估假体相关并发症发生情况,包括异位骨化(heterotopic ossification,HO)、椎体前缘骨吸收(anterior bone loss,ABL)及假体下沉。结果术后两组患者均获随访,随访时间24~120个月,平均53.4个月。两组手术时间、术中出血量、随访时间比较差异均无统计学意义(P>0.05);晚期干预组术后住院时间长于早期干预组(P<0.05)。末次随访时,两组患者JOA评分、NDI及VAS评分的手术前后变化值比较差异均无统计学意义(P>0.05)。随访期间两组均未出现手术翻修者,末次随访时两组HO、ABL及假体下沉发生情况比较差异均无统计学意义(P>0.05)。影像学评估示,手术前后各时间点两组间CL、C2~C7 ROM、DA、DROM、DIH差异均无统计学意义(P>0.05)。组内比较示,早期干预组末次随访时尚能维持术后即刻的CL,而晚期干预组CL已恢复术前水平;两组患者C2~C7ROM、DROM及DA在末次随访时均恢复至术前水平,DIH在术后即刻均显著增大,并维持至末次随访。结论术前症状持续时间对CSR患者CDA术后疗效具有显著影响,与术前症状持续时间<24个月患者相比,≥24个月者术后住院时间更长,CL的维持能力可能更差。
Objective To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty(CDA)in cervical spondylotic radiculopathy(CSR)patients.Methods The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed.Based on preoperative symptom duration,patients were divided into an early intervention group(preoperative symptom duration<24 months)and a late intervention group(preoperative symptom duration≥24 months).There was no significant difference in baseline data between the two groups(P>0.05),including age,gender,body mass index,smoking status,surgical segment,preoperative neck disability index(NDI),visual analogue scale(VAS)score,cervical lordosis(CL),C2-C7 range of motion(ROM),disc angle(DA),disc ROM(DROM),and disc intervertebral height(DIH).The early intervention group had a slightly higher preoperative Japan Orthopedic Association(JOA)score than the late intervention group(P<0.05).Perioperative indicators such as operation time,intraoperative blood loss,and postoperative hospital stay were recorded.The changes of JOA score,NDI,and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy,and the imaging evaluation of CL,C2-C7 ROM,DA,DROM,and DIH was performed before operation,immediately after operation,and at last follow-up.The incidence of prosthesis-related complications,including heterotopic ossification(HO),anterior bone loss(ABL),and prosthesis subsidence,was also assessed at last follow-up.Results Patients in both groups were followed up 24-120 months,with an average of 53.4 months.There was no significant difference in operation time,intraoperative blood loss,or follow-up duration between the groups(P>0.05).However,the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group(P<0.05).At last follow-up,there was no significant difference in the changes of JOA score,NDI,and VAS score between the two groups before and after operation(P>0.05).During the follow-up,there was no surgical revision in the two groups,and there was no significant difference in the incidence of HO,ABL,and prosthesis subsidence between the two groups at last follow-up(P>0.05).Imaging evaluation showed that there was no significant difference in CL,C2-C7 ROM,DA,DROM,and DIH between the two groups at each time point before and after operation(P>0.05).The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up,while the late intervention group had recovered to the preoperative level.Additionally,the C2-C7 ROM,DROM,and DA had all recovered to preoperative levels at last follow-up in both groups;meanwhile,the DIH significantly increased immediately after operation and sustained until the last follow-up.Conclusion Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients.Patients with preoperative symptom duration≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration<24 months.
作者
李益
何俊波
吴廷奎
丁琛
王贝宇
刘浩
LI Yi;HE Junbo;WU Tingkui;DING Chen;WANG Beiyu;LIU Hao(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第2期176-182,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金面上项目(82172522)
四川省干部保健重点研发项目(川干研ZH2023-105)。
关键词
术前症状持续时间
神经根型颈椎病
人工颈椎间盘置换术
颈椎曲度
Preoperative symptom duration
cervical spondylotic radiculopathy
cervical disc arthroplasty
cervical lordosis
作者简介
通信作者:刘浩,Email:liuhao6304@126.com。
