背景:平山病(HD)患者越来越多地进行手术治疗,以限制颈部过度屈曲并恢复颈椎前凸。然而,宫颈前凸丢失术后复发可能会重新开始HD的进展。许多研究已经证明了颈部肌肉力量和颈椎曲度之间的关系,人们普遍认为,休闲时间体育活动(LTPA)可以增加肌肉力量。然而,关于LTPA与术后颈椎曲度维持的相关性的报道很少。
目的:量化HD患者手术前后的宫颈前凸和运动功能,并分析术后LTPA水平对这些测量值变化的影响。
方法:对91例HD患者进行了C2-7Cobb测定,手术后2-5天和大约2年。所有患者在手术前和手术后约2年进行运动单元数估计(MUNE)和握力(HGS)。在62例患者中测量了颈后肌的横截面积和脂肪浸润。在术后2年评估时,对所有患者进行了长期国际身体活动问卷及其不同领域的评估。
结果:术后2年左右,C2-7Cobb比术前评估时更大(P<0.05)。术前到术后C2-7Cobb的变化与术后症状侧HGS和双侧MUNE测量值的变化有关(P<0.05)。重要的是,与未使用LTPA的患者相比,使用LTPA的患者在术后即刻至大约2年后C2-7Cobb的改善更大,并且在最后一次随访时C2-7Cobb的改善更大。而且前者的症状侧MUNE测量值和症状侧HGS的术后改善也大于后者(P<0.05).
结论:术后LTPA对宫颈曲度的恢复/维持有积极作用,这可能会减轻HD患者上肢远端运动单位的损失。因此,术后LTPA可能有利于HD患者的术后康复或早期保守治疗.
BACKGROUND: Surgical treatment has been increasingly performed in Hirayama disease (HD) patients to limit excessive neck flexion and restore cervical lordosis. However, postoperative recurrence of cervical lordosis loss may restart the progress of HD. Many studies have demonstrated a relationship between neck muscle strength and cervical lordosis, and it is widely accepted that leisure-time physical activity (LTPA) can increase muscle strength. However, there are few reports about the correlation between LTPA and maintenance of postoperative cervical curvature.
OBJECTIVE: To quantify the cervical lordosis and motor function before and after operation in HD patients and to analyze the impact of postoperative LTPA levels on the changes in these measurements.
METHODS: C2-7 Cobb were measured in 91 HD patients before, 2-5 days and approximately 2 years after operation. Motor unit number estimation (MUNE) and handgrip strength (HGS) were performed in all patients before and approximately 2 years after operation, and both cross-sectional area and fatty infiltration of posterior cervical muscles were measured in 62 patients. Long-form international Physical Activity Questionnaire and its different domains was administered to all patients at postoperative 2-year assessments.
RESULTS: The C2-7 Cobb was larger immediately and approximately 2 years after operation than that at preoperative assessment (P < 0.05). The preoperative to postoperative change in C2-7 Cobb was associated with postoperative changes in the symptomatic-side HGS and bilateral MUNE measurements (P < 0.05). Importantly, the patients performing LTPA had greater improvements in C2-7 Cobb from immediate to approximately 2 years after operation and greater C2-7 Cobb at last follow-up than those without LTPA, and postoperative improvements in both symptomatic-side MUNE measurements and symptomatic-side HGS were also greater in the former than in the latter (P < 0.05).
CONCLUSIONS: Postoperative LTPA has a positive effect on recovery/maintenance of cervical lordosis after operation, which may alleviate the motor unit loss of distal upper limbs in HD patients. Therefore, postoperative LTPA may be beneficial for postoperative rehabilitation or early conservative treatment of HD patients.