影响颈椎后纵韧带骨化症单开门术疗效的因素△

Factors impacting clinical outcomes of unilateral open-door cervical laminoplasty for ossification of the posterior longitudi⁃ nal ligament

摘要:

[目的] 分析影响颈椎后纵韧带骨化症 （ossification of the posterior longitudinal ligament, OPLL） 单开门椎板成形术疗效的相关因素。[方法]回顾性分析 2015 年—2022 年于宁夏医科大学总医院行 C₃~C₇单开门术的 67 例颈椎 OPLL 患者的临床资料。采用单因素比较、多因素 Logistic 回归分析和列线图预测模型分析影响 OPLL 的相关因素。[结果]所有患者顺利完成手术，随访 24 个月以上。按末次随访时 JOA 评分改善率＜60%或≥60%，33 例列为不佳组，占 49.3%；34 例列为良好组，占 50.7%。不佳组年龄 [(59.1±9.9) 岁 vs (52.9±9.8) 岁, P=0.010]、椎管占位率 [(50.1±15.2)% vs (41.7±12.2)%, P=0.036]、T₁倾斜角（T₁ slop, T₁S） [(26.8±8.7)° vs (21.5±5.8)°, P=0.013] 、K 线阴性比率 [-/+, (11/22) vs (4/30), P=0.034] 和髓内高信号比率 [是/否, (20/13) vs (10/24), P=0.010] 均显著大于良好组。多因素逻辑回归分析显示，椎管占位率（OR=83.54, P=0.006）、髓内明显高信号（OR=3.13, P=0.004）、T1S （OR=1.11, P=0.036） 是临床疗效不佳的独立危险因素。预测模型 ROC 曲线下面积为 AUC=0.80 （95%CI 0.70~ 0.91, P＜0.001），校准曲线斜率接近 1，表明该预测模型准确性良好。[结论] 椎管占位率高、髓内信号强度、T₁S 大是影响手术疗效不佳的独立危险因素。

Abstract:

[Objective] To explore the factors impacting clinical outcomes of posterior open-door cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL). [Methods] A retrospective study was done on 67 patients who underwent C₃~C₇ open-door lamino- plasty for cervical OPLL in General Hospital of Ningxia Medical University from 2015 to 2022. Univariate comparison and multiple logistic re- gression were used to analyze the related factors impacting the clinical consequences. [Results] All patients had operation completed success- fully, and were followed up for more than 24 months. According to the improvement rate of JOA score ＜60% or ≥60% at the last follow-up, 33 patients were termed as the poor group, accounting for 49.3%, while the remaining 34 patients fell into the good group, accounting for 50.7%. As results of univariate comparison, the poor group proved significantly greater than the good group in terms of age [(59.1± 9.9) years vs (52.9± 9.8) years, P=0.010], the occupying rate of cervical canal preoperatively [(50.1±15.2)% vs (41.7±12.2)%, P=0.036], T₁ slop (T₁S) [(26.8±8.7)° vs (21.5±5.8)°, P=0.013], K line negative ratio [negative /positive, (11/22) vs (4/30), P=0.034] and intramedullary high signal ratio [yes/no, (20/ 13) vs (10/24), P=0.010]. Regarding to multivariate logistic regression, the canal occupying rate (OR=83.54, P=0.006), intramedullary high signal on MRI (OR=3.13, P=0.004) and T1S (OR=1.11, P=0.036) were independent risk factors for poor clinical outcomes. The area under curve (AUC) of the predicting model analyzed by ROC was of 0.80, 95%CI 0.70~0.91, P=0.001, with the slope of the calibration curve close to 1, indicating good accuracy of the prediction model. [Conclusion] The high spinal canal occupying rate, high intramedullary signal intensity and high T₁S are independent risk factors for poor surgical outcomes of open-door cervical laminoplasty for OPLL.