颈椎后纵韧带骨化后路椎管扩大预后的相关因素△（开放获取）

Factors related to prognosis of cervical unilateral open door laminoplasty for ossification of the posterior longitudinal ligament (OA)

摘要:

[目的]分析颈椎后纵韧带骨化症（cervical ossification of the posterior longitudinal ligament, C-OPLL）行颈后路单开门椎管扩大成形术（cervical unilateral open door laminoplasty, UODL）临床恢复的预测因素。[方法]回顾性分析 2013 年 1 月—2021 年 1 月接受 UODL 手术治疗的 OPLL 患者 316 例患者的临床资料，术前采用作者创立的脊髓后方压迫评分 （posterior compression score of spinal cord, PCS）对 MRI 影像进行评估。采用单因素比较和多元逐步回归分析评价影响临床恢复的相关因素。[结果]所有患者均顺利完成手术，未发生严重神经损伤、感染等并发症。患者平均随访时间（53.7±23.3）个月，根据术后 2 年时 J0A 评分恢复率，160 例 J0A 评分恢复率≥50%的患者为恢复好组，另外 156 例 J0A 评分恢复率＜50%的患者为恢复差组。恢复好组的病程 [(20.3±7.6) 个月 vs (29.2±8.7) 个月, P＜0.001] 显著短于恢复差组、脊髓高信号的发生率 [例, 有/无 (36/124) vs (70/86), P＜0.001] 显著低于恢复差组、PCS 评分 [(10.7±3.4) vs (5.7±2.6), P＜0.001] 显著大于恢复差组。两组在年龄、性别构成、BMI、高血压病史比率、糖尿病病史比率、吸烟史比率、脑卒中比率、术前 C_2~7 Cobb 角、C_2~7 SVA、T1 slope、K 线、骨化累及椎体数、骨化占位率、骨化厚度、术后康复训练比例方面差异均无统计学意义（P＞0.05）。多元线性逐步回归方程为：Y=7.395-0.306×病程+5.832×术前 PCS 评分，多元逐步回归分析结果表明，病程长（B=-0.306, P＜0.001）和术前 PCS 评分低（B=5.832, P＜0.001）是术后神经恢复差的主要相关因素。[结论]病程长是术后神经恢复差的危险因素，而术前 PCS 评分高是术后神经恢复好的积极因素。

Abstract:

[Objective] To explore the predictive factors of clinical recovery in cervical unilateral open-door laminoplasty (UODL) for the cervical ossification of the posterior longitudinal ligament (C-OPLL). [Methods] A retrospective analysis was conducted on 316 patients who underwent UODL for C-OPLL in our department from January 2013 to January 2021. The posterior compression score of spinal cord (PCS) created by us was used to evaluate MRI images before surgery. Univariate omparison and multiple stepwise regression analysis were used to evaluate the factors related to clinical recovery. [Results] All patients had UODL performed successfully without serious nerve injury, infection and other complications. The mean follow-up time of patients was of (53.7±23.3) months. According to the recovery rate of JOA score 2 years after surgery, 160 patients with J0A score recovery rate ≥50% were considered as good recovery group (the GR), while other 156 patients with JOA score recovery rate ＜50% were considered as poor recovery group (the PR). The GR group proved a significantly shorter duration of the disease [(20.3±7.6) months vs (29.2±8.7) months, P＜0.001], significantly lower incidence of high signal on MRI preoperatively [yes/no, (36/124) vs (70/86), P＜0.001], whereas significantly higher PCS score [(10.7±3.4) vs (5.7±2.6), P＜0.001] than the PR group. However, there were no significant differences in terms of age, gender composition, body mass index (BMI), previous hypertension, diabetes, smoking and stroke histories, preoperative C_2~7 Cobb angle, C_2~7 SVA, T1 slope, K-line, number of vertebra involved in ossification, ossification occupying rate, ossification thickness, and postoperative rehabilitation training ratio between the two groups (P＞0.05). As result of multiple linear stepwise regression, the equation was as follows: Y=7.395-0.306×disease course +5.832× preoperative PCS score, which meaned long disease course (B=-0.306, P＜0.001), while low preoperative PCS score (B=5,832, P＜0.001) were the main factors related to poor postoperative recovery. [Conclusion] Long disease course is a risk factor for poor postoperative recovery, while high preoperative PCS score is a positive factor for good postoperative recovery.