脊髓型颈椎病ACDF术后近期颈椎矢状位参数的变化及意义

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Abstract Objective To compare the difference of cervical sagittal parameters between normal subjects and patients with cervical spondylotic myelopathy (CSM)，and to explore the influence of the changes of cervical sagittal parameters before and after anterior discectomy and interbody fusion (ACDF) on the surgical efficacy. Methods The cervical spine DR examination results of 96 normal physical examinees from June 2019 to June 2020 in the physical examination center of the Affiliated Hospital of Youjiang Medical College for Nationalities were collected，and the medical records and follow-up results of 76 patients with CSM in the department of spine and bone diseases of the Affiliated Hospital of Youjiang Medical College for Nationalities from January 2016 to October 2019 were collected.The C_2～7 Cobb angle，C_2～7sagittal vertical axis (C_2～7 SVA)，T₁ slope (T₁S) and thoracic inlet angle (TIA) were measured in normal subjects and CSM patients before and after operation，The Japanese Orthopaedic Association scores (JOA)，neck disability index (NDI) and visual analogue score (VAS) were collected before and 12 months after surgery.Results The difference of C_2～7 Cobb angle，C_2～7 SVA，T₁S and TIA between healthy group and CSM group hasstatistically significant (P＜0.05)；the comparison of the four parameters were (18.86±7.22)°、 (12.09±3.51)°，(14.00±6.00)mm、 (19.38±4.65)mm，(25.99±4.27)°、(23.41±5.63)°，(82.40±7.03)°、 (77.64±7.27)°.The difference of JOA score，NDI index and VAS score of CSM patients before and after ACDF had statistically significant.C_2～7 Cobb angle，C_2～7 SVA，T₁S and TIA changed from (12.09±3.51) °，(19.38±4.65)mm，(23.41±5.63)°，(77.64±7.27)°preoperatively to (17.19±5.06) °，(15.24±4.24)mm，(24.67±3.39)°，(79.46±5.39)°postoperatively，respectively.The difference of C_2～7 Cobb angle before and after CSM was correlated with the difference of evaluation index (P＜0.05)，but the difference of C_2～7 SVA，T₁S and TIA was not correlated with the difference of evaluation index (P＞0.05).The preoperative JOA score，NDI index and VAS score of high and low Cobb angle group，C_2～7 SVA Group，T₁S group and TIA group were not statistically significant；the postoperative JOA score，NDI index and VAS score of high and low C_2～7 Cobb angle group were statistically significant (P＜0.05)；while the postoperative JOA score，NDI index and VAS score of high and low C_2～7 SVA Group，T₁S group and TIA group were not statistically significant (P＞0.05).Conclusion Normal subjects have larger C_2～7 Cobb angle and smaller C_2～7 SVA，T₁S and TIA than CSM patients；the imbalance of cervical sagittal position may increase the risk of neck pain and CSM.The C_2～7 Cobb angle will increased，C_2～7 SVA will decreased，and T₁S and TIA will be close to those before operation.The C_2～7 Cobb angle is related to the improvement of clinical symptoms，but the other three parameters are not.

Key words： cervical spondylotic myelopathy cervical sagittal parameters anterior surgery

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