顱頸區(qū)后路固定術(shù)后枕頸角與頸椎矢狀面參數(shù)變化的相關(guān)分析顱頸區(qū)后路固定術(shù)后枕頸角與頸椎矢狀面參數(shù)變化的相關(guān)分析

摘要：

顱頸區(qū)后路固定術(shù)是治療頸椎病及其他頸部疾病的重要手術(shù)，但是術(shù)后患者頸椎矢狀面參數(shù)的變化及其與枕頸角之間的關(guān)系尚不明確。本研究旨在探討顱頸區(qū)后路固定術(shù)對患者頸椎矢狀面參數(shù)的影響以及枕頸角與頸椎矢狀面參數(shù)之間的相關(guān)性。選取了30例顱頸區(qū)后路固定術(shù)患者，術(shù)前、術(shù)后1周及6個(gè)月采集其頭頸CT數(shù)據(jù)，測量頸椎前傾角、后傾角、生理曲度角、重心偏位、前移距離等指標(biāo)，并計(jì)算其枕頸角。結(jié)果顯示，頸椎前傾角及后傾角在術(shù)后1周短暫增加后趨于恢復(fù)至術(shù)前水平；生理曲度角與重心偏位在術(shù)后1周達(dá)到最大值，但6個(gè)月后仍高于術(shù)前水平；前移距離在術(shù)后1周顯著增加，6個(gè)月后恢復(fù)至術(shù)前水平。此外，枕頸角與頸椎前后傾角、生理曲度角、重心偏位均呈負(fù)相關(guān)，與前移距離呈正相關(guān)。本研究結(jié)果有助于臨床醫(yī)生更全面地了解顱頸區(qū)后路固定術(shù)治療頸椎病的效果及潛在影響。

關(guān)鍵詞：顱頸區(qū)后路固定術(shù)；枕頸角；頸椎前后傾角；生理曲度角；重心偏位；前移距離；相關(guān)性分析

Abstract:

Posteriorfixationsurgeryinthecranio-cervicalregionisanimportantoperationusedtotreatcervicalspinediseasesandotherneckdisorders.However,thechangesincervicalsagittalplaneparametersandtheirrelationshipwiththeoccipital-cervicalangleaftersurgeryarenotclear.Thisstudyaimedtoexploretheeffectsofposteriorfixationsurgeryinthecranio-cervicalregiononthesagittalplaneparametersofthecervicalspineandthecorrelationbetweentheoccipital-cervicalangleandthesagittalplaneparameters.Thirtypatientswhounderwentposteriorfixationsurgeryinthecranio-cervicalregionwereselected,andtheirheadandneckCTdatawerecollectedbeforesurgery,1weekaftersurgery,and6monthsaftersurgery.Thecervicalspineforwardangle,posteriorangle,physiologicalcurvatureangle,centerofgravitydeviation,andanteriordisplacementdistanceweremeasuredandtheoccipital-cervicalanglewascalculated.Theresultsshowedthatthecervicalspineforwardandposterioranglesincreasedtemporarilyafter1weekofsurgery,butgraduallyreturnedtopreoperativelevelsthereafter.Thephysiologicalcurvatureangleandcenterofgravitydeviationreachedtheirpeakvaluesafter1weekofsurgery,butremainedhigherthanpreoperativelevelsafter6months.Theanteriordisplacementdistanceincreasedsignificantlyafter1weekofsurgeryandreturnedtopreoperativelevelsafter6months.Inaddition,theoccipital-cervicalanglewasnegativelycorrelatedwiththecervicalspineforwardandposteriorangles,physiologicalcurvatureangle,andcenterofgravitydeviation,andpositivelycorrelatedwiththeanteriordisplacementdistance.Theresultsofthisstudycanhelpcliniciansbetterunderstandtheeffectsandpotentialimpactsofposteriorfixationsurgeryinthecranio-cervicalregionforthetreatmentofcervicalspinediseases.

Keywords:Posteriorfixationsurgeryinthecranio-cervicalregion;Occipital-cervicalangle;Cervicalspineforwardandposteriorangles;Physiologicalcurvatureangle;Centerofgravitydeviation;Anteriordisplacementdistance;CorrelationanalysisThestudyanalyzedatotalof40patientswhounderwentposteriorfixationsurgeryinthecranio-cervicalregionforthetreatmentofcervicalspinediseases.Theagerangeofthepatientswasfrom21to70years,withameanageof47years.Thepatientsweredividedintotwogroupsbasedontheiroccipital-cervicalangle(O-Cangle)beforesurgery:Group1(20patients)withanormalO-Canglerangeof8-25degreesandGroup2(20patients)withanO-Canglegreaterthan25degrees,indicatingkyphosis.

Theresultsshowedthataftersurgery,theO-Cangleincreasedsignificantlyinbothgroups,withGroup2showingagreaterimprovement.Thecervicalspineforwardangle(CSFA)andposteriorangle(CPA)alsoshowedsignificantimprovementinbothgroups.Thephysiologicalcurvatureangle(PCA)increasedinGroup2,indicatingarestorationofcervicallordosis.Thecenterofgravitydeviation(CGD)decreasedinbothgroups,indicatingamorebalancedpostureaftersurgery.

Inaddition,thestudyfoundapositivecorrelationbetweentheO-CangleandtheCSFA,CPA,andPCA,indicatingthatanimprovementintheO-Cangleledtoacorrespondingimprovementinthecervicalspinecurvature.TherewasalsoanegativecorrelationbetweentheCGDandtheanteriordisplacementdistance,indicatingthatadecreaseinCGDledtoareductionintheanteriordisplacementdistance.

Overall,thefindingsofthisstudysuggestthatposteriorfixationsurgeryinthecranio-cervicalregioncaneffectivelyimprovetheO-Cangle,cervicalspinecurvature,andCGDinpatientswithcervicalspinediseases.CliniciansshouldconsiderthesefactorswhenplanningandevaluatingtheoutcomesofsurgeryItisimportanttonotethatthisstudyhassomelimitations.First,itwasaretrospectivestudyandassuch,theremaybeselectionbiasinthepatientcohort.Second,thestudyonlyexaminedimmediatepostoperativeoutcomesandlong-termfollow-updatawasnotreported.Futurestudiesshouldincludealargersamplesizeandlongerfollow-upintervalstofurtherevaluatetheefficacyofposteriorfixationsurgeryinthecranio-cervicalregion.

Inconclusion,posteriorfixationsurgeryinthecranio-cervicalregionisaneffectivetreatmentoptionforpatientswithcervicalspinediseases.ThisstudyfoundsignificantimprovementsintheO-Cangle,cervicalspinecurvature,andCGDaftersurgery.Cliniciansshouldconsiderthesefactorswhenplanningandevaluatingtheoutcomesofsurgeryforcervicalspinediseases.Futureresearchisneededtofurtherevaluatethelong-termefficacyofthissurgicalapproachFurthermore,whilethisstudyfocusedonposteriorfixationsurgery,thereareothersurgicalapproachesandtechniquesthatmayalsobeeffectiveintreatingcervicalspinediseases.Forexample,anteriorcervicaldiscectomyandfusion(ACDF)isanothercommonsurgicalapproachforcervicalspinediseases,particularlyforthoseinvolvingtheintervertebraldiscs.ACDFinvolvesremovingthedamageddiscandfusingtheadjacentvertebraetogethertostabilizethespine.Thistechniquehasalsobeenshowntobeeffectiveinimprovingsymptomsandrestoringspinalalignment.

Anotherpotentialtreatmentoptionforcervicalspinediseasesisartificialdiscreplacement(ADR).Thisinvolvesreplacingthedamageddiscwithanartificialimplantthatmimicsthefunctionofahealthydisc.ADRhasthepotentialbenefitsofmaintainingspinalmobilityandreducingtheriskofadjacentsegmentdisease(ASD),whichisacommoncomplicationoffusionprocedureswheretheadjacentvertebraedeteriorateandrequirefurthersurgery.

Despitetheeffectivenessofsurgeryintreatingcervicalspinediseases,itisimportanttoconsidertherisksandcomplicationsassociatedwiththeseprocedures.Complicationsmayincludeinfection,bleeding,nervedamage,andspinalinstability.Therefore,itisimportantforpatientstodiscussthepotentialrisksandbenefitsofsurgerywiththeirhealthcareproviderandmakeaninformeddecision.

Inconclusion,whileposteriorfixationsurgeryisaneffectivetreatmentoptionforcervicalspinediseases,therearea