【摘要】 目的 探讨前路颈椎间盘切除椎间融合（ACDF）术对术后椎旁肌肉的影响以及ACDF术后椎旁肌肉的改变是否会影响术后临床症状。方法 选取2018年6月至2020年6月于郑州大学第一附属医院骨科接受ACDF术的50例单节段脊髓型颈椎病（CSM）患者作为手术组，选取同期在医院体检中心接受颈椎磁共振成像（MRI）检查的80例健康体检者作为健康组，测量相应平面肌肉及脂肪T₂加权像上的横截面并计算脂肪与肌肉面积之比。比较健康组和手术组患者脂肪与肌肉面积比，比较手术组患者术前和末次随访时的脂肪与肌肉面积比。使用视觉模拟评分法（VAS）评估患者疼痛程度，采用颈椎功能障碍指数（NDI）评估患者残疾程度，采用改良颈椎日本骨科协会评分（mJOA）评估患者神经功能损伤程度。采用Spearman相关性分析比较脂肪与肌肉面积比与VAS、NDI、mJOA评分的关系。结果 健康组人群脂肪与肌肉面积比中位数为0.44（0.33,0.66）,手术组患者术前及末次随访时的脂肪与肌肉面积比中位数分别为0.66（0.56,1.21）和0.77（0.58,1.28）。健康组和手术组脂肪与肌肉面积比比较，差异有统计学意义（P<0.05）;手术组患者术前和末次随访时的脂肪与肌肉面积比比较，差异有统计学意义（P<0.05）。对功能评分和影像学数据进行相关性分析，发现术前和末次随访时的NDI、VAS评分分别与术前和末次随访的脂肪与肌肉面积比呈正相关（P<0.05）。未发现mJOA评分和脂肪与肌肉面积比具有相关性（P>0.05）。结论 ACDF手术可能与单节段CSM患者术后颈部肌肉退变有关，患者术后疼痛程度与相应节段椎旁肌肉的退变程度呈正相关，椎旁肌肉加权像上的横截面越小，其颈部疼痛症状越重，但与术后神经功能的恢复无相关性。更多还原

【Abstract】 Objective To investigate the effect of anterior cervical discectomy and fusion（ACDF） on postoperative paravertebral muscles and whether the changes of paravertebral muscles after ACDF will affect postoperative clinical symptoms.Methods A total of 50 patients with single segment cervical spondylotic myelopathy（CSM） who underwent ACDF in the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2020 were selected as operation group, and 80 healthy subjects who underwent cervical magnetic resonance imaging（MRI） during the same period in physical examination center of the hospital were selected as healthy group. The cross-section of T₂ weighted images of corresponding plane muscles and fats was measured, and the ratio of fat to muscle area was calculated. And the ratio of fat to muscle area between operation group and healthy group, the ratio of fat to muscle area in operation group before operation and at the last follow-up were compared. Visual analogue scale（VAS） was used to evaluate the degree of pain, cervical disability index（NDI） was used to evaluate the degree of disability and modified Japanese Orthopaedic Association（mJOA） was used to evaluate the degree of neurological impairment. The Spearman correlation analysis was used to compare the relationship between the ratio of fat to muscle area and VAS, NDI, mJOA scores.Results The median of the ratio of fat to muscle area was 0.44（0.33, 0.66） in healthy group. The median of the ratio of fat to muscle area in operation group before operation and at the last follow-up were 0.66（0.56, 1.21） and 0.77（0.58, 1.28）. There was statistical difference in the ratio of fat to muscle area between healthy group and operation group（P<0.05）. There was statistical difference in the ratio of fat to muscle area in operation group before operation and at the last follow-up（P<0.05）. The correlation analysis between functional score and imaging data showed that the NDI scores and VAS scores before operation and at the last follow-up were positively correlated with the ratio of fat to muscle area before operation and at the last follow-up（P<0.05）. No correlation was found between mJOA score and the ratio of fat to muscle area（P>0.05）.Conclusion ACDF surgery may be related to the degeneration of cervical muscles in patients with single segment CSM. The degree of postoperative pain is positively correlated with the degeneration of paravertebral muscles in corresponding segments. The smaller the cross section on the weighted image of paravertebral muscles, the more severe the symptoms of neck pain, but it has no correlation with the recovery of postoperative neurological function.更多还原