Bryan颈椎间盘置换术治疗颈椎病的早期临床研究

Treatment of Cervical Spine Disease with the Bryan Cervical Disc Prosthesis Replacement

目的探讨Bryan人工颈椎间盘置换术缓解颈椎病神经症状和体征,提高患者生活质量,并保持颈椎稳定和节段活动.方法对2003年12月至2004年10月我科12 例14个颈椎间盘置换术进行了随访.随访时间2～8个月,平均5.2个月.其中脊髓型颈椎病5 例,颈椎间盘突出症7 例.男7 例,女5 例.年龄35～62 岁,平均50.3 岁.单节段置换10 例,双节段置换2 例.结果平均手术时间单节段置换为(130±50) min,双节段置换为(165±53) min(从切开皮肤到缝合皮肤计算).术中及术后没有神经和血管损伤的并发症.JOA评分从平均8.6增加到15.8.没有假体下沉和明显偏移.置换节段稳定并部分恢复了颈椎正常的活动范围,前屈和后伸活动范围是4.68°(3.6°～6.1°);左右侧屈的活动范围是3.51°(2.5°～4.6°)、3.42°(2.6°～4.3°).CT和MRI随访表明,14个椎间盘中,有2个节段的假体偏移小于1.5 mm,1个节段的假体偏移在1.5～3.0 mm之间.颈椎的生理弧度没有明显丢失.置换节段假体周围未见骨化.结论 12 例人工颈椎间盘置换术取得了满意的近期疗效.与颈椎前路椎间盘摘除植骨融合术最大的不同是患者功能恢复快,没有颈椎活动受限的缺陷.但至少需要5 a的长期随访才能评价假体的功能和对邻近节段的影响.

Objective To determine whether new functional intervertebral cervical disc prosthesis can provide relief from objective neurologic symptoms and signs, improve the ability of daily living, alleviate the pain of patients, and maintain the stability and segmental motion of cervical vertebrae. Methods Twelve cases, fourteen discs （male 7, female 5, age from 35 to 62 years, mean age 50.3 years） who underwent artifical cervical disc replacement from December 2003 to Octomber 2004 were followed-up. The follow-up time was 2 to 8 months,the averge time was 5.2 months. Among the cases, there were 5 cases of cervical spondylotic myelopathy and 7 cases of cervical disc herniation. 10 cases were replaced single level, 2 cases were replaced bi level. Results The operation time for the single disc replacement was （130±50） minutes and bi level replacement was （165± 53） minutes（records as skin to skin）. The neurological or vascular complications were not observed during or after operation. There was no prothesis subsidence or excursion. JOA score increased from averaged 8.6 to 15.8. The replaced segment achived stability and partial of ROM,4.68°（3.6°-6.1°） in flextion and extension position, 3. 51°（2.5°-4.6°） and 3.42°（2.6°-4.6°） in left and right bending position. No obvious loss of lordosis was found. CT and MRI images showed that 2/14 discs had no more than 1.5 mm excursion, and 1/14 disc excursion was between 1.5 mm and 3 mm. There was no obvious ossification around the replaced levels. Conclusion It is a good early outcome for artifical cervical disc replacement. Discectomy and implantation of the device alleviated neurologic symptoms and signs. Radiographic evidences proved that the ROM of cervical was maintained. At least 5 years of followed up time should be needed to assess the longterm functionality of the prosthesis and the influence on adjacent levels.