颈椎后路单开门椎管扩大椎板成形术对颈椎矢状面平衡的影响

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Abstract Objective To explore the changes of cervical sagittal balance after posterior cervical expansive open-door laminoplasty procedure.Methods The radiological and clinical data were analyzed retrospectively for 108 patients undergoing posterior cervical expansive open-door laminoplasty (C₃~C₇) in Department of Orthopaedic Surgery，ShanXi Bethune Hospital，from January 2014 to December 2017.The C_0～2 Cobb angle，C_2～7 SVA，C_2～7 Cobb angle，and T1-Slope were recorded before operation and at the 24thmonth follow-up.The preoperative and the 24thmonth follow-up Japanese Orthopaedic Association (JOA) score，neck disabilityindex (NDI)，the MOS item short from health survey(SF-36)，visual analog scale (VAS) were recorded respectively，the severity of axial symptoms was also recorded at the 24th month follow-up.Results The JOA score and SF-36 score increased to (14.08±2.17)，(51.25±5.82) from pre-operative (11.16±2.28)，(42.76±5.63).The NDI score and VAS score decreased from pre-operative (15.61±5.43)，(4.64±1.87) to (11.36±7.93)，(3.31±1.62) at the 24th month follow-up，respectively，the value changes were all statistically significant (P＝0.001，P＝0.001，P＝0.001，P＝0.022).The C_0～2 Cobb angle，C_2～7 SVA increase to(15.36±4.51)°，(25.49±11.52)mm formpre-operative (11.37±5.54)°，(21.09±5.86)mm，C_2～7 Cobb angle decrease to(10.65±8.72)°frompre-operative (13.93±8.68)°，the value changes were all respectively statisticallysignificant (P＝0.001，P＝0.001，P＝0.016).T1-slope changed from (26.84±5.10)° before operation to (26.31±4.8) °，the difference was not statistically significant (P＝0.186).The change in C_0～2 Cobb angle was positively related to the change in C_2～7 SVA(Pearson=0.420，P＝0.015).At the 24th month follow-up，the average VAS score of high T1 group was (3.13±1.60) and low T1 group was (2.45±1.31)，the differences were statisticallysignificant between the 2 groups (P=0.015).The incidence of severe axial symptoms was 64.8% in the high T1-Slope group and 33.3% in the low T1-Slope group.Conclusion There was significant impact of posterior cervical expansive open-door laminoplasty procedure on cervical sagittal balance.The cervical vertebrae show a tendency of tilting forward，suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.And more severe axial symptoms often occurs in patients with high T1-Slope.

Key words： cervical cervical spondylotic myelopathy posterior laminoplasty sagittal balance

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