术前K线倾斜角预测后纵韧带骨化症单开门术后疗效的可行性分析

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摘要目的探讨术前K线倾斜角预测单开门椎管扩大成形术治疗后纵韧带骨化症患者临床疗效的可行性。方法回顾性分析2019年2月至2022年1月行颈椎后路单开门椎管扩大成形术治疗的52例K线阳性后纵韧带骨化症(ossification of the posterior longitudinal ligament，OPLL)患者资料，其中男35例，女17例；年龄47~76岁，平均(61.46±7.26)岁。统计患者术前日本骨科协会(Japanese orthopedic association，JOA)评分、术后1年随访时JOA评分。颈椎中立侧位X线片测量术前矢状面参数：K线倾斜角、C_2~7Cobb角、C_2~7矢状面轴向距离(C_2~7 sagittal vertical axis，C_2~7 SVA)、头部重心(center gravity of head，CGH)~C₇矢状面轴向距离(CGH~C₇ SVA)、T₁倾斜角。根据术后1年时JOA评分改善中位数分为改善优良组和改善较差组，采用单因素方差分析判断矢状位参数与疗效之间的关系，采用Pearson分析检验参数间的相关性。将有统计学差异的颈椎参数作为自变量，将JOA评分作为因变量，行Logistic回归分析影响术后JOA改善率的危险因素。结果所有患者的术后临床症状均得到改善。OPLL患者术前JOA评分为(7.38±0.89)分，术前C_2~7Cobb角(14.45±8.81)°，C_2~7SVA(15.31±4.57)mm，CGH~C₇ SVA(16.37±5.23)mm，T₁倾斜角(26.43±5.65)°、K线倾斜角(12.77±1.49)°。根据术后1年随访时JOA评分改善情况分组显示：术前K线倾斜角、C_2~7SVA、CGH~C7 SVA与术后疗效密切相关(P＜0.001、P＝0.013、P＝0.022)；术前K线倾斜角与C_2~7SVA、CGH~C₇ SVA呈正相关(r＝0.411、0.831，P＝0.004、0.023)。上述相关性指标经Logistic回归分析显示：影响OPLL单开门术后疗效的危险因素为术前K线倾斜角和术前CGH~C₇ SVA(OR=1.673、1.522，P＝0.024、0.033)。结论 OPLL患者术后疗效与术前K线倾斜角度有关，术前K线倾斜角较大，患者术后疗效较差。K线倾斜角可作为一种新的临床指标用于颈椎后路单开门术前预测OPLL患者术后疗效。

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	王春增
	张建伟
	胡孟子
	韩猛
	张兆川
	李杰
	刘光旺

关键词 ：后纵韧带骨化症, K线倾斜角, 单开门扩大成形术, 颈椎矢状面参数

Abstract：

Objective To explore the feasibility of predicting the clinical effect of single open door laminoplasty in the treatment of ossification of the posterior longitudinal ligament by the preoperative K line tilt.Methods The data of 52 patients with ossification of the posterior longitudinal ligament (OPLL) with positive K line who were treated by posterior cervical singledoor laminoplasty from February 2019 to January 2022 were analyzed retrospectively.35 male and 17 female were included.The patients age from 47 to 76 years，with an average of (61.46±7.26)years.The score of the Japanese orthopedic association (JOA) before the operation and the JOA score at the oneyear followup after the operation were recorded.The parameters of sagittal plane before operation were measured on the neutral lateral radiograph of cervical spine，which including Kline tilt，C_2~7 Cobb angle，C_2~7sagittal vertical axis (C_2~7 SVA)，center gravity of head (CGH) ~ C₇ sagittal axial distance (CGH~C₇ SVA)，T₁ slope.According to the median JOA score 1 year after surgery，patients were divided into good improvement group and poor improvement group.The preoperative K-line tilt and other sagittal plane parameters were used as independent variables.One-way analysis of variance and Logistic regression were used to analyze the risk factors affecting the postoperative JOA improvement rate.Results The clinical symptoms of all patients were improved.The preoperative C_2~7 Cobb angle was (14.45±8.81)°，C_2~7 SVA was (15.31±4.57)mm，CGH~C₇ SVA was (16.37±5.23)mm，T₁slop was (26.43±5.65)°，K-line tilt was (12.77±1.49)° and preoperative JOA score of OPLL patients were (7.38±0.89) points.According to the improvement rate of JOA score at 1 year follow-up，the analysis of preoperative cervical sagittal parameters after grouping showed that the preoperative kline tilt，preoperative C_2~7SVA，preoperative CGH~C₇ SVA (P＜0.001，P＝0.013，P＝0.022) were closely related to the postoperative efficacy，and the preoperative K-line tilt was positively correlated with C_2~7SVA，CGH~C₇SVA(r＝0.411，r＝0.831，P＝0.004，P＝0.023).Logistic regression analysis showed that preoperative K-line tilt and preoperative CGH~C₇ SVA (OR=1.673，OR=1.522，P＝0.024，P＝0.033) were the risk factors affecting postoperative efficacy.Conclusion The postoperative efficacy of patients with OPLL is related to the preoperative K line tilt.The patients with large preoperative K line tilt have poor postoperative efficacy.The K line tilt can be used as a new clinical index to predict the postoperative efficacy of patients with OPLL before single-door surgery through the posterior cervical spine.

Key words： ossification of the posterior longitudinal ligament K-line tilt laminoplasty cervical sagittal parameters

基金资助:徐州市引进临床医学专家团队项目(2019TD002)

作者简介: 王春增(1982－ )，男，副主任医师，徐州市中心医院脊柱外科，172647352@qq.com

引用本文:

王春增，张建伟，胡孟子，韩猛，张兆川，李杰，刘光旺. 术前K线倾斜角预测后纵韧带骨化症单开门术后疗效的可行性分析[J]. 实用骨科杂志, 2023, 29(11): 961-.
Wang Chunzeng，Zhang Jianwei，Hu Menzi，Han Meng，Zhang Zhaochuan，Li Jie，Liu Guangwang. Feasibility Analysis of Predicting the Clinical Effect of Single Open Door Laminoplasty in the Treatment of Ossification of the Posterior Longitudinal Ligament By the Preoperative K Line Tilt. sygkzz, 2023, 29(11): 961-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I11/961

［1］Le HV，Wick JB，Van BW，et al.Ossification of the posterior longitudinal ligament：Pathophysiology，diagnosis and management［J］.J Am Acad Orthop Surg，2022，30(17)：820-830.
［2］Weinberg DS，Rhee JM.Cervical laminoplasty：Indication，technique，complications［J］.J Spine Surg，2020，6(1)：290-301.
［3］董敏杰，徐辰，张一智，等.后纵韧带骨化症患者术前颈椎矢状位参数对术后疗效的影响［J］.中国脊柱脊髓杂志，2021，31(12)：1106-1111.
［4］余文超，袁文，陈华江，等.脊髓型颈椎病颈前路手术对术后颈椎矢状位平衡参数的影响［J］.中华骨科杂志，2018，38(21)：1285-1292.
［5］Kim HS，Kim TH，Park MS，et al.K-line tilt as a novel radiographic parameter in cervical sagittal alignment［J］.European Spine J，2018，27(8)：2023-2028.
［6］Fujiyoshi T，Yamazaki M，Kawabe J，et al.A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament：The K-line［J］.Spine (Phila Pa 1976)，2008，33(26)：E990-E993.
［7］谢政，皮国富，孙建广，等.K线阳性颈椎后纵韧带骨化症患者后路术后神经功能改善多因素分析［J］.河南医学研究，2020，29(6)：999-1002.
［8］刘晓伟，陈德玉，王新伟，等.颈椎后纵韧带骨化症患者K线对两种颈后路手术疗效的影响［J］.中国脊柱脊髓杂志，2013，23(1)：6-10.
［9］Lan Z，Wu Z，Xu W，et al.Analysis of a radiographic parameter K-line tilt following adjacent twolevel anterior cervical discectomy and fusion：A retrospective study［J］.J Orthop Surg Res，2020，15(1)：131.
［10］Azimi P，Yazdanian T，Benzel EC，et al.Sagittal balance of the cervical spine：A systematic review and metaanalysis［J］.Eur Spine J，2021，30(6)：1411-1439.
［11］王春增，李杰，赵猛，等.侧块螺钉结合椎管成形翻修颈前路术后邻椎退变［J］.中国矫形外科杂志，2020，28(5)：400-404.
［12］李祖昌，蒋继乐，何达，等.颈椎矢状面平衡参数与颈椎手术关系的研究进展［J］.中华骨科杂志，2021，41(8)：532-540.
［13］魏柏兴.术前K线倾斜角与颈椎后纵韧带骨化症行双开门椎管扩大成形术预后的相关性分析［D］.吉林大学，2022.
［14］孙康，朱卫国，鲁世保.颈椎矢状位参数与颈后肌群质量的相关性［J］.脊柱外科杂志，2022，20(2)：111-115.
［15］陈华，刘浩，龚全，等.颈椎单开门椎管扩大椎板成形微型钢板内固定术后轴性疼痛的危险因素［J］.中国脊柱脊髓杂志，2018，28(2)：111-117.
［16］苗军，刘艳成，兰杰，等.改良微型钛板重建伸肌附着点在颈后路单开门椎管扩大成形术中的应用［J］.中华医学杂志，2019，99(17)：1312-1316.
［17］Kim JT，Lee HJ，Choi DY，et al.Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine［J］.Eur Spine J，2016，25(7)：2223-2232.
［18］臧法智，陈华江，王建喜，等.T₁倾斜角对颈椎后纵韧带骨化患者后路单开门椎板成形术后颈椎曲度的影响［J］.脊柱外科杂志，2016，14(1)：26-29.
［19］Wei B，Liu W，Wu H.Analysis between preoperative cervical radiographic parameters represented by the K-line tilt and the short-term prognosis of laminoplasty for posterior longitudinal ligament ossification：A retrospective study［J］.Front Surg，2022(9)：1-11
［20］Lee JS，Son DW，Lee SH，et al.The predictable factors of the postoperative kyphotic change of sagittal alignment of the cervical spine after the laminoplasty［J］.J Korean Neurosurg Soc，2017，60(5)：577-583.