前路颈椎融合临床评分与影像测量的相关性△

Correlation between clinical scores and imaging measurements in anterior cervical discectomy and fusion

摘要:

[目的]探讨前路颈椎融合术对颈椎影像学参数的影响及颈椎影像学参数与临床评分的相关性。[方法]回顾性分析 2019 年 4 月—2021 年 4 月在本院行颈前路减压融合术治疗退行性颈椎病 128 例患者的临床资料。分析临床评分与影像测量的相关性。[结果]所有患者手术顺利完成，术中无严重并发症，随访 12~20 个月，平均(14.5±1.9)个月。随时间推移，128 例患者的 JOA 评分显著增加(P＜0.05)，而 NDI 和 VAS 评分均显著下降(P＜0.05)。随时间推移，寰椎倾斜角无显著变化(P＞0.05)； 与术前相比，术后 1 年时枢椎倾斜角显著减小(P＜0.05)；术后 1 年时上颈椎曲度较术前显著减少(P＜0.05)。随时间推移，下颈椎曲度呈先上升后下降趋势，差异有统计学意义 (P＜0.05)。相关分析方面，术前 JOA 评分与寰椎倾斜角呈显著负相关 (P＜ 0.05)；NDI 评分与枢椎倾斜角呈显著正相关(P＜0.05)。术后 1 年 JOA 评分与寰椎倾斜角呈显著负相关(P＜0.05)；NDI 评分与枢椎倾斜角呈显著正相关(P＜0.05)。其他临床和影像指标间不存在相关性(P＞0.05)。[结论] 前路颈椎减压融合手术能够改善颈椎功能及生活质量，影像参数在一定程度上反映临床效果。

Abstract:

[Objective] To explore the effect of anterior cervical discectomy and fusion (ACDF) on radiographic parameters of the cervi- cal spine and the correlation between imaging parameters and clinical scores. [Methods] A retrospective study was conducted on 128 pa- tients who received ACDF for cervical degenerative diseases (CDD) in our hospital from April 2019 to April 2021. The correlation between clinical score and imaging measurement was analyzed. [Results] All patients had ACDF performed successfully without serious complica- tions, and followed up for 12~20 months with an average of (14.5±1.9) months. The JOA score increased significantly (P＜0.05) , while the NDI and VAS scores decreased significantly over time (P＜0.05) . In terms of radiographic measurements, the C₁ inclination angle remained unchanged over time (P＞0.05) , whereas the C₂ inclination angle significantly reduced at 1 year after surgery (P＜0.05) , the upper cervical curvature significantly reduced at 1 year after operation compared with that before surgery (P＜0.05) , and the lower cervical curvature tended to first rise and then decreased with statistically significant differences over time (P＜0.05) . As results of correlation analysis, preoperative JOA score was negatively correlated with the C₁ inclination angle (P＜0.05) , additionally, the NDI score was positively correlated with C₂ in- clination angle (P＜0.05) . At 1 year postoperatively, the JOA score proved still negatively correlated with the C₁ inclination angle (P＜0.05) , whereas NDI score was positively correlated with C₂ inclination angle (P＜0.05) . However, no correlation was found between other clinical and radiological parameters (P＞0.05) . [Conclusion] The ACDF does improve cervical function and quality of life of the patients, and imag- ing parameters might reflect clinical outcomes to a certain extent.