脊髓型颈椎病椎板成形术后颈椎前凸丢失的影响因素分析

Analysis of factors affecting cervical lordosis loss after laminoplasty for cervical spondylotic myelopathy

摘要:

目的 分析脊髓型颈椎病（CSM）椎板成形术后颈椎前凸丢失的影响因素。方法 选取2022年1月—2025年1月沧州市中心医院123例CSM患者作为研究对象。根据术后前凸丢失情况分为前凸严重丢失组（35例）与无前凸严重丢失组（88例）。收集所有患者性别、年龄、体质量指数、病程等基线资料及颈椎矢状面参数，并对两组进行比较。采用多因素一般Logistic回归模型分析CSM患者术后颈椎前凸丢失的影响因素。结果 前凸严重丢失组与无前凸严重丢失组的性别、年龄、体质量指数、病程、手术节段数、手术入路、合并高血压、合并糖尿病、颈痛及骨密度分类构成比较，差异均无统计学意义（P >0.05）。前凸严重丢失组患者的C₂或C₇累及、术前前凸角度（CL）、C₇倾斜角、C₂-C₇曲率及屈曲活动范围较无前凸严重丢失组高（P <0.05）。前凸严重丢失组与无前凸严重丢失组的术前颈椎对齐情况、术前手术节段CL、CSVA、伸展活动范围比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：累及C₂或C₇［O^R=6.465（95% CI：1.544，27.074）］、术前CL大［O^R=1.404（95% CI：1.215，1.621）］、C₇倾斜角大［O^R=1.299（95% CI：1.144，1.476）］、C₂-C₇曲率高［O^R=3.323（95% CI：1.488，7.423）］、屈曲活动范围大［O^R=2.117（95% CI：1.584，2.830）］均为CSM患者术后前凸严重丢失的危险因素（P <0.05）。结论 CSM患者颈椎损伤累及C₂或C₇时，在椎板成形术后出现颈椎前凸严重丢失；同时患者的颈椎矢状面参数包括术前CL、C₇倾斜角、C₂-C₇曲率及屈曲活动范围更大时，术后也更易出现颈椎前凸严重丢失。

Abstract:

Objective To investigate the preoperative factors affecting cervical lordosis loss after laminoplasty in cervical spondylotic myelopathy (CSM).Methods From January 2022 to January 2025, 123 CSM patients admitted to our hospital were selected as the study subjects. They were divided into a severe loss of lordosis group (n = 35) and a non-severe loss of lordosis group (n = 88) based on the degree of lordosis loss. Baseline data and cervical sagittal parameters were collected and compared between the two groups. Multivariate logistic regression analysis was used to identify factors influencing postoperative cervical lordosis loss.Results Patients in the severe loss group had higher rates of C₂ or C₇ involvement, higher preoperative cervical lordosis (CL), larger C₇ slope, larger C₂-C₇ curvature, and greater flexion range of motion (P < 0.05). Multivariate logistic regression analysis showed that involvement of C₂ or C₇ [O^R = 6.465 (95% CI: 1.544, 27.074) ], high preoperative CL [O^R = 1.404 (95% CI: 1.215, 1.621) ], large C₇ slope [O^R = 1.299 (95% CI: 1.144, 1.476) ], high C₂-C₇ curvature [O^R = 3.323 (95% CI: 1.488, 7.423) ], and large flexion range of motion [O^R = 2.117 (95% CI: 1.584, 2.830) ] were all risk factors for severe loss of postoperative lordosis in CSM patients (P < 0.05).Conclusion Patients with CSM who have cervical injuries involving C₂ or C₇ are prone to severe loss of lordosis after laminoplasty; moreover, patients with larger preoperative values of cervical sagittal parameters are also more likely to experience loss of lordosis postoperatively.