目的探讨多点刺激运动单位估数(motor unit number estimation,MUNE)评价平山病患者颈椎前路融合内固定术后疗效的价值。方法回顾性分析2007年10月至2016年5月接受颈椎前路植骨融合内固定手术治疗的36例平山病患者的病历资料,男35例,女1...目的探讨多点刺激运动单位估数(motor unit number estimation,MUNE)评价平山病患者颈椎前路融合内固定术后疗效的价值。方法回顾性分析2007年10月至2016年5月接受颈椎前路植骨融合内固定手术治疗的36例平山病患者的病历资料,男35例,女1例;年龄16~26岁,平均(19.2±2.8)岁;单侧发病26例,双侧发病10例,共46侧肢体。分别记录术前、末次随访时患侧肢体的拇短展肌和小指展肌MUNE数值,采用Odom评价标准评估患者术后疗效。并依据Odom评价结果进行分组,优、良为疗效满意组,可、差为疗效不满意组。手术前后MUNE数值比较采用独立样本t检验;依据Odom评价结果分组后采用配对样本t检验进行组间比较;采用Pearson相关分析手术疗效(Odom评价结果)与患者年龄、病程、随访时间、术前MUNE、术后MUNE的相关性。结果36例患者随访时间为12~96个月,平均(28.2±17.0)个月。末次随访时46侧肢体Odom评价结果显示优8侧,良18侧,可20侧。末次随访时所有患者拇短展肌MUNE值为188.2±60.4较术前139.6±68.4明显增加(t=-5.86,P<0.001),增加值为48.7±56.3;小指展肌MUNE值为104.2±80.4较术前75.0±66.3明显增加(t=-3.86,P<0.01),增加值为29.2±51.4。疗效满意组患者年龄、随访时间、术前拇短展肌和小指展肌MUNE数值、与疗效不满意组比较,差异均无统计学意义,显示两组患者的基线资料具有可比性。组间比较结果显示,疗效满意组的病程(24.0±11.3)个月,短于疗效不满意组的(34.9±21.2)个月(t=-4.452,P<0.01);疗效满意组末次随访时拇短展肌MUNE增加值为65.6±64.1,小指展肌MUNE增加值为42.6±59.3,分别明显优于疗效不满意组的26.7±34.7(t=2.446,P<0.05)和11.8±32.4(t=2.088,P<0.05)。结论多点刺激运动单位估数(MUNE)可以定量评估平山病患者肢体的神经功能,可以作为平山病患者术后疗效的观察指标。展开更多
Background Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy （CSM）. This study aimed to investigate the profiles of and correlation between objective and subjective short-term...Background Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy （CSM）. This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM. Methods We retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011. Both objective and subjective assessments were evaluated before surgery, 3 months after surgery, and 1 year after surgery. We then analyzed the profiles of and correlation between objective and subjective short-term outcomes. Results The Modified Japanese Orthopaedic Association （mJOA） score was significantly improved at 3 months （P〈0.01） and 1 year （P〈0.01） after surgery. Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery, while motor function contributed more to the recovery rate at 1 year after surgery. On the subjective assessment （the short form （SF）-36）, there was no significant improvement at 3 months after surgery （P〉0.05）, while physical function （PF）, role-physical （RP）, and social function （SF） were notably improved at 1 year after surgery （P〈0.01）. Improved mJOA score correlated with improvements in PF, RP, bodily pain, general health （GH）, vitality （VT）, and SF （P〈0.05） at 3 months after surgery; PF, GH, VT, and SF were associated with improved mJOA scores at 1 year after surgery. Conclusions Patients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function, followed by a gradual transition to motor function improvement. At the early stage of recovery, improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36, while at the later stage, mJOA score improvement was associated with improvements in both mental and physical domains of the SF-36.Chin med J 2014;127（14）：2659-2663展开更多
文摘目的探讨多点刺激运动单位估数(motor unit number estimation,MUNE)评价平山病患者颈椎前路融合内固定术后疗效的价值。方法回顾性分析2007年10月至2016年5月接受颈椎前路植骨融合内固定手术治疗的36例平山病患者的病历资料,男35例,女1例;年龄16~26岁,平均(19.2±2.8)岁;单侧发病26例,双侧发病10例,共46侧肢体。分别记录术前、末次随访时患侧肢体的拇短展肌和小指展肌MUNE数值,采用Odom评价标准评估患者术后疗效。并依据Odom评价结果进行分组,优、良为疗效满意组,可、差为疗效不满意组。手术前后MUNE数值比较采用独立样本t检验;依据Odom评价结果分组后采用配对样本t检验进行组间比较;采用Pearson相关分析手术疗效(Odom评价结果)与患者年龄、病程、随访时间、术前MUNE、术后MUNE的相关性。结果36例患者随访时间为12~96个月,平均(28.2±17.0)个月。末次随访时46侧肢体Odom评价结果显示优8侧,良18侧,可20侧。末次随访时所有患者拇短展肌MUNE值为188.2±60.4较术前139.6±68.4明显增加(t=-5.86,P<0.001),增加值为48.7±56.3;小指展肌MUNE值为104.2±80.4较术前75.0±66.3明显增加(t=-3.86,P<0.01),增加值为29.2±51.4。疗效满意组患者年龄、随访时间、术前拇短展肌和小指展肌MUNE数值、与疗效不满意组比较,差异均无统计学意义,显示两组患者的基线资料具有可比性。组间比较结果显示,疗效满意组的病程(24.0±11.3)个月,短于疗效不满意组的(34.9±21.2)个月(t=-4.452,P<0.01);疗效满意组末次随访时拇短展肌MUNE增加值为65.6±64.1,小指展肌MUNE增加值为42.6±59.3,分别明显优于疗效不满意组的26.7±34.7(t=2.446,P<0.05)和11.8±32.4(t=2.088,P<0.05)。结论多点刺激运动单位估数(MUNE)可以定量评估平山病患者肢体的神经功能,可以作为平山病患者术后疗效的观察指标。
文摘Background Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy （CSM）. This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM. Methods We retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011. Both objective and subjective assessments were evaluated before surgery, 3 months after surgery, and 1 year after surgery. We then analyzed the profiles of and correlation between objective and subjective short-term outcomes. Results The Modified Japanese Orthopaedic Association （mJOA） score was significantly improved at 3 months （P〈0.01） and 1 year （P〈0.01） after surgery. Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery, while motor function contributed more to the recovery rate at 1 year after surgery. On the subjective assessment （the short form （SF）-36）, there was no significant improvement at 3 months after surgery （P〉0.05）, while physical function （PF）, role-physical （RP）, and social function （SF） were notably improved at 1 year after surgery （P〈0.01）. Improved mJOA score correlated with improvements in PF, RP, bodily pain, general health （GH）, vitality （VT）, and SF （P〈0.05） at 3 months after surgery; PF, GH, VT, and SF were associated with improved mJOA scores at 1 year after surgery. Conclusions Patients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function, followed by a gradual transition to motor function improvement. At the early stage of recovery, improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36, while at the later stage, mJOA score improvement was associated with improvements in both mental and physical domains of the SF-36.Chin med J 2014;127（14）：2659-2663
