颈人工椎间盘置换术的临床应用初步报告

Clinical report of cervical arthroplasty in management of cervical spondylosis

目的探索颈人工椎间盘假体应用于颈椎病患者的手术操作要点和早期治疗效果,观察假体植入后的稳定性和植入节段的活动度.方法对4例脊髓型颈椎病患者(5个节段)行颈前路间隙减压,Brayn颈椎间盘假体置换术,在此基础上对4例患者纵行切取颈长肌内侧肌瓣,交叉缝合,防止人工椎间盘移位.术前、术后进行JOA评分和Odem评分比较评价早期治疗效果;术后摄置换节段前屈后伸位,左右侧屈位X线片,观察稳定性和植入节段的活动度.术后3个月进行置换间隙CT或MRI扫描观察是否存在早期异位骨化现象.结果本组患者术后无并发症,临床症状明显缓解、脊髓功能改善.JOA评分由术前平均9.0(6～11)分上升至术后平均16.0(14～17)分.4例患者术后3个月置换节段前屈后伸活动范围平均4.8(4.0～5.7)度,左右侧屈活动范围分别为3.48(3.3～3.7)度和3.26(2.6～3.7)度.未发现假体偏移或下沉.CT或MRI扫描显示:假体上、下金属壳位于临近下、上终板骨的中央,未见假体周围的异位骨化现象.结论颈人工椎间盘置换术保持前路减压的良好效果,同时取得了很好的术后稳定性,保持了颈椎正常的活动度,为颈椎病的治疗提供了一种新的途径,颈长肌皮瓣交叉缝合对颈人工椎间盘向前脱出有一定阻挡作用.

Objective To investigate clinical effects and manual point with cervical disc prostbesis in patients with cervical spondylosis, to observe the stability and range of movement （ROM） postoperatively. Metheds Brayn disc prosthesis replacement was applied in 4 eases （5 levels） of cervical spondylosis. On the basis, the longus collis musle （LCM） flaps were made in 4 patients.Then they were sutured to the contralateral LCM in a cross shape, Clinic（JOA grade and Odem＇s scale） and radiologieal （X-ray of bending,extending;left and right bending position） followup was performed postoperatively, Systemic radiographic study about stabihty and ROM of replaced level postoperatively was measured. CT or MRI scan was applied in 3 months postoperatively to find out the excursion of the prosthesis and heterotopie ossification in the replaced level. Results There was no comphcation, Improvement in all eases increased obviously, JOA score increased from average 9, 0 to 16.0. Replaced segment achieved stability and restored partial of normal ROM,4.86°（4.0～5.7°） in flex and extension position and 3.48°（3.3～3.7°）,3.26°（2.6～3.7°） in left and right bending position. There was no prosthesis subsidence or excursion. Replaced segment achieved stability and restored partial of normal ROM. No obvious loss of lordsis was found, and no heterotopic ossification in the replaced level. Conclusion Brayn cervical disc prosthesis restored motion to the level of the intact segment in flexionextersion and lateral bending in postoperational images. At the same time , it can achieve good anterior decompression treatment effect and immediate stability in replaced level and which is a new choice for the treatment of cervical spondylosis. LCM flap can be sutured to prevent the slip of the intervertebral disc.