单开门椎板成形术后不同时长佩戴颈托对临床结局的影响：一项回顾性队列研究

宋继鹏; 林万程; 姚思远; 卢雨征; 张垚; 易蒙; 姚明涛; 罗正宁; 杨嘉琪; 丁立祥

doi:10.12435/j.issn.2095-5227.2023.098

单开门椎板成形术后不同时长佩戴颈托对临床结局的影响：一项回顾性队列研究

Clinical outcomes of different durations of rigid cervical collar use on clinical outcomes after single-door laminoplasty: A retrospective cohort study

摘要

摘要:
背景颈托常规用于保持术后颈部刚性固定和避免并发症。目前未见文献报道关于颈托的不同佩戴时长对颈椎单开门椎板成形术后临床疗效的影响。
目的比较不同颈托佩戴时长(2周vs 3个月)对单开门椎板成形术后患者颈部不适、功能恢复和影像学结果的影响。
方法回顾性分析首都医科大学附属北京世纪坛医院脊柱外科2017年1月- 2018年12月接受颈椎单开门椎板成形术并持续佩戴颈托3个月的患者(长期组)和2019年1月至2020年12月接受同样手术并持续佩戴颈托2周的患者(短期组)，术后1年内的视觉模拟量表(visual analog scale，VAS)、颈部残疾指数(neck disability index，NDI)、日本骨科协会(Japanese Orthopaedic Association，JOA)评分以及术后颈部活动度(range of room，ROM)和门轴愈合率等方面的差异。
结果研究共纳入69例患者(短期组33例，长期组36例)，其中男性44例，女性25例，平均年龄为(54.09 ± 9.92)岁。短期组患者术后3周和3个月时的VAS(3周：2.92 vs 1.48，P=0.003；3个月：2.67 vs 1.69，P=0.027)和NDI(3周：35.82 vs 26.41，P=0.016；3个月：33.56 vs 24.92，P=0.013)评分较长期组差，术后3个月时的ROM较长期组有明显优势(23.03° vs 30.78°，P＜0.001)，其余各时间点两组VAS、NDI以及ROM均无显著差异。两组患者术后JOA评分和门轴愈合率在各随访时间点上均无显著差异。
结论缩短颈托佩戴时间没有明显劣势，短时间佩戴颈托的患者相较于长期的患者，在术后1年的功能评分、门轴愈合率以及颈部ROM等方面没有显著差异。因此我们建议外科医生可以在术后评估患者状况后缩短颈托的佩戴时长。

Abstract:
Background Rigid cervical collar is commonly used to maintain the rigid fixation of the neck after surgery and prevent postoperative complications. To date, there is no literature report about the effects of different durations of rigid cervical collar use on clinical outcomes after single-door laminoplasty.
Objective To compare the effects of different durations of rigid cervical collar use (2 weeks vs 3 months) on neck discomfort, functional recovery and imaging results of patients after single-door laminoplasty.
Methods Patients who underwent single-door laminoplasty and used a cervical collar for 3 months from January 2017 to December 2018 (long-duration group) and those who underwent the same procedure and used a cervical collar for 2 weeks from January 2019 to December 2020 (short-duration group) were reviewed. The VAS score, NDI score, JOA score, healing rate of hinge, and cervical ROM were compared between the two groups within one year after surgery.
Results A total of 69 patients (33 cases in the short-term group and 36 cases in the long-term group) were included in the study, including 44 males and 25 females, with an average age of 54.09 ± 9.92 years old. The scores of VAS (postoperative 3 weeks: 2.92 vs 1.48, P=0.003; postoperative 3 months: 2.67 vs 1.69, P=0.027) and NDI (postoperative 3 weeks: 35.82 vs 26.41, P=0.016; postoperative 3 months: 33.56 vs 24.92, P=0.013) in the trail group were worse than those in the long duration group at 3 weeks and 3 months after surgery, and the ROM at postoperative 3 months was significantly better to that in the short duration group (23.03° vs 30.78°, P0.000). No significant difference in VAS, NDI and ROM between the two groups at other time points was observed. The postoperative JOA score and healing rate of hinge in the two groups were similar at each follow-up time point.
Conclusion The results of our historical cohort study show that there is no obvious disadvantage in shortening the duration of rigid cervical collar use. No significant differences in the functional score, the healing rate of hinge, and cervical ROM are observed in the patients who had a short-duration collar compared with long-duration collar in postoperative one year. Therefore, we suggest that the duration of rigid cervical collar can be shortened after evaluating the patient's condition after surgery.

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