Temporal changes of hand dexterity in patients with cervical spondylotic myelopathy after decompression surgery
廖天颖 1梁国彦 1叶勇裕 1陈俊颖 1昌耘冰1
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作者信息
1. 广东省人民医院(广东省医学科学院)脊柱外科 510080 广州市
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摘要
目的:探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者行减压手术后1年手灵活性变化的时间规律,构建预测术后手灵活性的模型并对其加以验证.方法:前瞻性纳入2021年10月～2022年10月于我院就诊的136例成年CSM患者,男性70例,女性66例,年龄56.37±11.12岁.分别在减压术前、术后6个月及12个月时评估十秒抓握试验结果、改良日本骨科协会(the modified Japanese Orthopaedic Association,mJOA)上肢运动功能(mJOA上肢运动功能)得分和JOA颈椎病评估问卷(JOA Cervical Myelopathy Evaluation Questionnaire,JOACMEQ)上肢功能得分.通过单因素方差分析比较各参数随时间的变化情况来研究CSM患者手功能变化的时间规律.采用单因素分析及多因素Logistic回归分析,筛查影响手灵活性的潜在危险因子并构建预后模型.模型的诊断效能由受试者工作特征(receiver operating characteristic,ROC)曲线分析和曲线下面积(area under the curve,AUC)衡量.结果:在术后6个月时,患者的mJOA得分由术前的13.09±2.42分提升至16.64±1.42分、mJOA上肢运动功能得分由术前的3.90±0.89分提升至4.77±0.48分、JOACMEQ上肢功能得分由术前的76.97±19.30分提升至90.45±14.70分,十秒抓握次数由术前的14.41±3.14次增加至18.16±4.63次(P值均＜0.001);在术后12个月时,患者的十秒抓握次数进一步提升至20.00±5.25次(P=0.038),而各主观评分则未见显著变化.术前十秒抓握次数、年龄和吸烟史是术后1年手灵活性受损的独立危险因子.ROC曲线分析验证了由这三个变量构建的预测模型,其AUC为0.780(95％置信区间=0.665～0.894).结论:衡量CSM患者手功能的主观指标在术后6个月会趋于稳定,而客观指标在1年内都有显著改善.根据患者术前十秒抓握次数、年龄和吸烟史,可预估患者1年后十秒抓握次数的恢复情况.
Abstract
Objectives:To elucidate the temporal pattern of hand dexterity changes in patients with cervical spondylotic myelopathy(CSM)one year after decompression surgery and to develop and validate a predictive model for hand dexterity improvement.Methods:A total of 136 adult patients with CSM(70 males and 66 females;mean age 56.37±11.12 years)treated in our hospital were prospectively enrolled between October 2021 and October 2022.Hand dexterity was assessed using the 10-second grip and release(10-s G&R)test,the modified Japanese Orthopaedic Association(mJOA)upper extremity motor function score,and the JO A cer-vical myelopathy evaluation questionnaire(JOACMEQ)upper extremity function before operation,and at 6 and 12 months after operation.A one-way ANOVA was conducted to examine the temporal pattern of hand func-tion improvement.Logistic regression analysis was performed to identify risk factors and develop a predictive model for postoperative hand dexterity impairment.The model's discrimination was assessed using receiver op-erating characteristic(ROC)curve and area under curve(AUC)analysis.Results:At 6 months after operation,significant improvements were observed in mJOA score(from 13.09±2.42 to 16.64±1.42 分),mJOA upper extremity motor function score(from 3.90±0.89 to 4.77±0.48),JOACMEQ upper extremity function score(from 76.97±19.30 to 90.45±14.70),and 10-s G&R test result(from 14.41±3.14 cycles to 18.16±4.63 cycles)(all P＜0.001);At 12 months after operation,the 10-s G&R test result further increased to 18.16±4.63 cycles(P=0.038),though no significant changes were noted in the subjective scores.The cycles of preoperative 10-s G&R test,as well as age and smoking status,were identified as the risk factors for hand dexterity impairment one year after surgery.The prediction model was validated with an AUC of 0.780(95％CI=0.665-0.894).Conclusions:Regarding the hand function of CSM patients after decompression surgery,subjective measurements typically stabilize at 6 months,while objective measurements continue to improve at 1 year.Based on the cycles of preoperative 10-s G&R test,age,and smoking status,the improvement in the cycles of the 10-s G&R test one year post-surgery can be predicted.
关键词
脊髓型颈椎病/手灵活性/患者报告的结局指标/十秒抓握试验/预测模型
Key words
Cervical spondylotic myelopathy/Hand dexterity/Patient-reported outcome measures/10-second Grip and Release Test/Prediction model
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