影响扩大颈椎管单开门成形疗效的相关因素△

Factors related to outcome of extended cervical opendoor laminoplasty

摘要:

[目的] 探讨椎管扩大成形术（expansive open-door laminoplasty, ELAP） 治疗多节段脊髓型颈椎病疗效的相关因素。[方法] 2020 年7 月—2023 年6 月因多节段脊髓型颈椎病行ELAP 手术治疗的患者196 例，采用单项因素比较和二元多因素逻辑回归分析影响神经功能恢复率的相关因素。[结果] 神经功能恢复率优良组149 例（恢复率≥50%），占76.0%；，不良组47 例（恢复率＜50%），占24.0%。单因素分析显示，不良组年龄[(62.2±8.8) 岁vs (56.3±10.2) 岁, P＜0.001]、BMI [(27.0±2.9) kg/m² vs (24.3±2.8) kg/m², P＜0.001]、高血压病占比[例(%), 24 (51.1) vs 32 (21.5), P＜0.001]、冠心病占比[例(%), 11(23.4) vs 8 (5.4), P＜0.001]、吸烟[是/否, 23/24 vs 37/112, P=0.002]、病程[(14.9±15.1) 个月vs (10.3±10.8) 个月, P=0.022] 均显著大于优良组。多因素逻辑回归显示吸烟史（OR=6.406, P＜0.001）、高血压病史（OR=5.204, P=0.005）、BMI（OR=1.396, P＜0.001）、年龄（OR=1.075, P=0.034） 是多节段CSM 经ELAP 治疗后神经恢复不良的独立危险因素；而术前JOA 评分（OR=0.465, P＜0.01） 及术后1 个月C2~7 Cobb 角（OR=0.841, P＜0.05） 则是术后神经功能恢复的保护因素。[结论] 年龄、BMI、高血压病史、吸烟史是多节段CSM 经ELAP 治疗后神经恢复不良的独立危险因素；术前JOA 评分及术后1 个月C2~7 Cobb 角则是神经恢复的保护因素。

Abstract:

[Objective] To explore the factors related to the clinical outcome of expansive open-door laminoplasty (ELAP) for treatmentof multilevel cervical spondylotic myelopathy. [Methods] From July 2020 to June 2023, 196 patients were treated with ELAP for multilevelcervical spondylotic myelopathy. Univariate comparison and binary multifactor logistic regression analysis were used to analyze the factorsrelated to the recovery rate of neurological function. [Results] Of them, 149 cases (76.0%) got excellent recovery of nerve function with recov-ery rate of ≥50% (the good group), whereas the remaining 47 cases (24.0%) got recovery rate ＜50% (the poor group). In term of univariatecomparison, the poor group proved significantly greater than the good group regarding to age [(62.2±8.8) years vs (56.3±10.2) years, P＜0.001], BMI [(27.0±2.9) kg/m² vs (24.3±2.8) kg/m², P＜0.001], hypertension ratio [cases (%), 24 (51.1) vs 32 (21.5), P＜0.001], coronary heartdisease [cases (%), 11 (23.4) vs 8 (5.4), P＜0.001], smoking [y/n, (23/24) vs (37/112), P=0.002], and duration of disease [(14.9±15.1) monthsvs (10.3±10.8) months, P=0.022]. As results of multivariate logistic regression, smoking (OR=6.406, P＜0.001), hypertension (OR=5.204, P=0.005), BMI (OR=1.396, P＜0.001), age (OR=1.075, P=0.034) were independent risk factors for poor neurological recovery after ELAP treat-ment in multi-segmental CSM. JOA score before surgery (OR=0.465, P＜0.01) and C2~7 Cobb angle 1 month after surgery (OR=0.841, P＜0.05) were protective factors for postoperative neurological recovery. [Conclusion] Age, BMI, history of hypertension, and smoking are inde-pendent risk factors for poor neurological recovery after ELAP treatment in multi-segmental CSM, while preoperative JOA score and C2~7Cobb angle 1 month after surgery are protective factors for nerve recovery.