脊髓型颈椎病患者前路椎体次全切除减压融合内固定术后邻近节段退变的预测因素

唐超; 杨科; 方静; 吴星火

doi:10.14188/j.1671-8852.2024.0373

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脊髓型颈椎病患者前路椎体次全切除减压融合内固定术后邻近节段退变的预测因素

临床医学研究 | 更新时间：2026-11-05

- 脊髓型颈椎病患者前路椎体次全切除减压融合内固定术后邻近节段退变的预测因素
- Predictors of adjacent segment degeneration in cervical spondylotic myelopathy patients after anterior subtotal vertebral resection decompression fusion internal fixation
- 武汉大学学报（医学版） 2025年46卷第10期页码：1321-1326
- 作者机构：
  
  1.洪湖市中医医院骨二科湖北洪湖 433200
  2.华中科技大学同济医学院附属协和医院脊柱外科湖北武汉 430021
- 作者简介：
  
  唐超，男，1986—，主治医师，主要从事骨科临床研究，E‑mail:xhl505050@163.com
- 基金信息：
  
  湖北省科技攻关计划项目(2021BGC010)
- DOI：10.14188/j.1671-8852.2024.0373
  中图分类号： R681.5
- 收稿：2024-05-15，
  
  纸质出版：2025-10-25
- 稿件说明：
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唐超,杨科,方静等.脊髓型颈椎病患者前路椎体次全切除减压融合内固定术后邻近节段退变的预测因素[J].武汉大学学报（医学版）,2025,46(10):1321-1326.

TANG Chao,YANG Ke,FANG Jing,et al.Predictors of adjacent segment degeneration in cervical spondylotic myelopathy patients after anterior subtotal vertebral resection decompression fusion internal fixation[J].Medical Journal of Wuhan University,2025,46(10):1321-1326.
唐超,杨科,方静等.脊髓型颈椎病患者前路椎体次全切除减压融合内固定术后邻近节段退变的预测因素[J].武汉大学学报（医学版）,2025,46(10):1321-1326. DOI： 10.14188/j.1671-8852.2024.0373.

TANG Chao,YANG Ke,FANG Jing,et al.Predictors of adjacent segment degeneration in cervical spondylotic myelopathy patients after anterior subtotal vertebral resection decompression fusion internal fixation[J].Medical Journal of Wuhan University,2025,46(10):1321-1326. DOI： 10.14188/j.1671-8852.2024.0373.

摘要

目的

分析脊髓型颈椎病（CSM）患者前路椎体次全切除减压融合内固定术（ACCF）后邻近节段退变（ASD）的预测因素。

方法

选取2017年7月至2020年7月在洪湖市中医医院进行ACCF手术，且术后随访2年的80例CSM患者为研究对象，按照ACCF术后是否发生ASD分为ASD组和无ASD组，结合临床资料及相关文献资料筛选出可能与ASD有关的危险因素，并采用多因素Logistic回归分析影响ASD的独立危险因素，通过对危险因素与是否发生ASD进行Pearson相关性分析，绘制受试者工作特征（ROC）曲线并分析影响CSM患者ACCF后ASD的因素。

结果

经ACCF术治疗的80例CSM患者经术后2年回访，有14例发生ASD，其余66例无ASD发生，ASD发生率为17.50%。ASD组与无ASD组患者的年龄、体质量指数、病程、脊髓T2WI高信号、脊髓压迫度、颈椎活动度、JOA评分、NDI评分差异有统计学意义（

0.05），性别、文化程度、吸烟史、喝酒史、手术时间、术中出血量、上肢VAS评分、颈部VAS评分比较差异无统计学意义（

0.05）；多因素Logistic回归分析发现患者的病程、脊髓压迫度和JOA评分与CSM患者行ACCF术后的ASD发生具有显著相关性（

0.05），是患者术后发生ASD的独立危险因素；Pearson相关性分析发现ASD发生与患者病程、脊髓压迫度呈现显著正相关性（

0.05），与JOA评分呈现显著负相关性（

0.05）；ROC曲线分析发现病程的曲线下面积（

AUC

）和灵敏度最佳，分别为0.756和78.6%，脊髓压迫度的特异度最佳为93.9%。

结论

患者病程、脊髓压迫度和JOA评分是患者术后发生ASD的独立危险因素，且患者病程、脊髓压迫度与ASD发生呈现显著的正相关性，与JOA评分呈现显著的负相关性。

Abstract

Objective

To analyze the predictors of adjacent segment degeneration (ASD) in the patients with cervical spondylotic myelopathy (CSM) after anterior subtotal vertebrotomy decompression fusion internal fixation (ACCF).

Methods

Eighty patients with CSM who underwent ACCF surgery in Honghu Hospital of Traditional Chinese Medicine from July 2017 to July 2020 and followed up for 2 years after surgery were selected as the study objects. According to whether they developed ASD after ACCF surgery

they were divided into ASD group and non⁃ASD group. Combined with clinical data and related literature

possible risk factors related to ASD were screened out. Multivariate Logistic regression was used to analyze the independent risk factors for ASD

Pearson correlation analysis was conducted between risk factors and whether ASD occurred

and receiver operating characteristics (ROC) curve was drawn to analyze the factors affecting ASD after ACCF in CSM patients.

Results

Among 80 patients with CSM treated by ACCF

14 developed ASD while the remaining 66 did not

yielding an incidence of 17.50%. There were significant differences in age

body mass index

disease course

spinal cord T2WI high signals

spinal cord compression

cervical motion

JOA score and NDI score between ASD group and non⁃ASD group (

0.05). There were no significant differences in gender

education level

smoking history

drinking history

operation time

intraoperative blood loss

VAS score of upper limb and VAS score of neck (

0.05). Multifactor Logistic regression analysis found that the course of disease

spinal cord compression and JOA score were significantly correlated with the incidence of ASD in CSM patients after ACCF (

0.05)

and were independent risk factors for postoperative ASD in CSM patients. Pearson correlati

on analysis showed that ASD occurrence was significantly positively correlated with the course of disease and spinal cord compression (

0.05)

and significantly negatively correlated with JOA score (

0.05). ROC curve analysis showed that the area under the curve (

AUC

) and sensitivity of the disease course were 0.756 and 78.6%

respectively

and the specificity of spinal cord compression was 93.9%.

Conclusion

Patients' disease course

spinal cord compression degree and JOA score are independent risk factors for postoperative ASD

and patients' disease course and spinal cord compression degree are significantly positively correlated with ASD occurrence

while significantly negatively correlated with JOA score

关键词

Keywords

references

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