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 open-door laminoplasty
田志康 1梁啸 2王梓焜 3张振宇 1鲍勇钢 1杨涛 2孟纯阳2
作者信息
- 1. 济宁医学院,山东济宁 272067
- 2. 济宁医学院附属医院脊柱外科,山东济宁 272007
- 3. 山东第一医科大学,山东济南 250024
- 折叠
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％o 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,23/24vs37/112,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C2～7Cobb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C2～7Cobb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 treatment of multilevel cervical spondylotic myelopathy.[Methods]From July 2020 to June 2023,196 patients were treated with ELAP for multilevel cervical spondylotic myelopathy.Univariate comparison and binary multifactor logistic regression analysis were used to analyze the factors related 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 univariate comparison,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 heart disease[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)months vs(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 C2～7 Cobb angle 1 month after surgery are protective factors for nerve recovery.
关键词
多节段脊髓型颈椎病/椎管扩大成形术/C2～7Cobb角/神经功能恢复率Key words
multilevel cervical spondylotic myelopathy/expansive open-door laminoplasty/C2～7 Cobb angle/nerve function recovery rate引用本文复制引用
基金项目
山东省自然科学基金重点项目(ZR2020KH010)
出版年
2024
NETL
NSTL
万方数据