| 吴浩然,张徐宏,宋韩霖,等.肥胖对脊髓型颈椎病患者术后步态参数及神经功能恢复的影响.骨科,2026,17(3): 208-212. |
| 肥胖对脊髓型颈椎病患者术后步态参数及神经功能恢复的影响 |
| Impact of obesity on postoperative gait parameters and neurological recovery in patients with cervical spondylotic myelopathy |
| 投稿时间：2026-01-26 |
| DOI：10.3969/j.issn.1674-8573.2026.03.002 |
| 中文关键词: 脊髓型颈椎病 身体质量指数 步态分析 神经功能恢复 颈前路椎间盘切除融合术 |
| 英文关键词: Cervical spondylotic myelopathy Body mass index Gait analysis Neurological recovery Anterior cervical discectomy and fusion |
| 基金项目:上海市教育委员会自然科学重大项目（2023科技05-60） |
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| 中文摘要: |
| 目的 探讨肥胖对脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者颈前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）术后步态参数和神经功能恢复的影响，阐明患者身体质量指数（BMI）与术后功能恢复的关系及其预测价值。方法 本研究为单中心前瞻性队列研究，连续纳入2020年1月至2022年12月接受ACDF术的CSM患者，根据WHO国际通用BMI标准分为三组：正常体重组（18.5 kg/m2≤BMI＜25 kg/m2）、超重组（25 kg/m2≤BMI＜30 kg/m2）和肥胖组（BMI≥30 kg/m2）。收集患者术前、术后6个月及术后2年的步态参数（时空参数、关节运动学、关节角加速度），并评估改良日本骨科协会（modified Japanese Orthopaedic Association，mJOA）评分，比较三组的恢复差异。采用协方差分析BMI分组对术后2年的步速和mJOA恢复率的影响；采用受试者工作特征曲线（ROC）分析确定预测神经功能恢复不良（术后2年mJOA恢复率＜55%）的BMI临界值。结果 最终纳入192例，正常体重组68例，超重组66例，肥胖组58例。术后6个月，除肥胖组的站立相百分比显著高于正常体重组（P＜0.05）外，其他指标组间差异均无统计学意义（均P＞0.05）。术后2年，多个步态参数显示出显著的梯度差异：步速、步频、步长、踝背伸角度、膝和髋关节角加速度均随BMI增加而逐渐降低（均P＜0.05）；神经功能恢复率也呈现相似梯度，正常体重组（72.51%）＞超重组（61.82%）＞肥胖组（48.30%），组间差异有统计学意义（P＜0.001）。协方差分析显示，BMI对术后2年的步速和mJOA恢复率均有独立影响（均P＜0.001）。ROC曲线分析确定术前BMI≥26.53 kg/m2（AUC=0.819，敏感性73.7%，特异性76.0%）为预测术后2年神经功能恢复不良的临界值。结论 肥胖是影响术后功能恢复的独立危险因素。术前BMI≥26.53 kg/m2能有效预测神经功能恢复不良，该阈值低于传统肥胖标准，提示CSM患者对体重的敏感性更高。 |
| 英文摘要: |
| Objective To investigate the impact of obesity on postoperative gait parameters and neurological recovery in patients with cervical spondylotic myelopathy (CSM) undergoing anterior cervical discectomy and fusion (ACDF), and to clarify the relationship between body mass index (BMI) and postoperative functional outcomes as well as its predictive value. Methods This was a single-center prospective cohort study. The CSM patients who underwent ACDF surgery between January 2020 and December 2022 were consecutively enrolled and divided into three groups according to the WHO BMI classification criteria: normal weight group (18.5 kg/m2≤BMI＜25 kg/m2), overweight group (25 kg/m2≤ BMI＜30 kg/m2), and obesity group (BMI≥30 kg/m2). Gait parameters (spatiotemporal parameters, joint kinematics, and angular accelerations) were collected and the modified Japanese Orthopaedic Association (mJOA) score was assessed preoperatively, at 6 months, and 2 years postoperatively. Covariance analysis was used to examine the influence of BMI grouping on step speed and mJOA recovery rates at 2 years postoperatively; Receiver operating characteristic (ROC) curve analysis was used to determine the BMI cut-off value for predicting poor neurological recovery (mJOA recovery rate ＜55% at 2 years post-surgery). Results A total of 192 cases were ultimately included, comprising 68 cases in the normal weight group, 66 cases in the overweight group, and 58 cases in the obese group. At 6 months postoperatively, only the stance phase percentage was significantly higher in the obesity group compared to the normal weight group (P＜0.05). At 2 years postoperatively, multiple gait parameters showed significant gradient differences: step speed, cadence, step length, ankle dorsiflexion angle, knee and hip joint angular accelerations all decreased progressively with increasing BMI (all P＜0.05). The neurological recovery rate showed a similar gradient (normal group: 72.51% > overweight group: 61.82%＞obesity group: 48.30%, P＜0.001). Analysis of covariance revealed that the BMI category had an independent effect on both step speed and mJOA recovery rates at 2 years postoperatively (both P＜0.001). ROC curve analysis identified a preoperative BMI of ≥26.53 kg/m2 as the cutoff value for predicting poor neurological recovery at 2 years postoperatively (AUC=0.819, sensitivity 73.7%, specificity 76.0%). Conclusion Obesity is an independent risk factor affecting postoperative functional recovery. A preoperative BMI≥26.53 kg/m2 can effectively predict poor neurological recovery, which is lower than the conventional obesity threshold, suggesting that CSM patients may be more sensitive to BMI-related effects. |
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