人工颈椎间盘置换治疗颈椎间盘突出症

Cervical arthroplasty in the management of cervical disc herniation

[目的]探讨Bryan人工颈椎间盘假体置换治疗颈椎间盘突出症的临床效果。[方法]本组14例颈椎间盘突出症患者，男10例，女4例；年龄31～52岁，平均43岁。C3、4例，C4、5，2例，C5、68例，C4、61例，C3-61例。单节段置换12例，双节段置换2例，共置换16个椎间盘假体。Bryan假体由金属外壳和聚氨酯髓核组成，外壳有钛微孔喷涂层。术后摄颈椎动态X线片观察假体稳定性及活动度。[结果]术后随访最长28个月，平均10个月。全部患者神经功能均有明显改善，CSM40分法评分平均提高8．5分，有效率为100％，无假体松动和脱落，术后置换节段活动度平均为6．4。。[结论]人工颈椎间盘假体置换具有确切的稳定性和相应的活动度，是治疗颈椎间盘突出症的可选择方式之一。早期临床效果良好，远期效果有待于进一步观察。

[ Objective] To evaluate the clinical result after treatment of disc herniation with the Bryan cervical disc prosthesis. [ Method] There were 14 cases with cervical disc herniation. There were 4 females and 10 males with ages ranging 31 - 52 years （mean age 43 years）. The herniated disc located at C3,4 in 2 cases, C4,5 in 2 cases, C5,6 in 8 cases, C4-6 in 1 case and C3 -6 in 1 case. A total of 16 Bryan cervical disc prosthesis were implanted. Single level disc was replaced in 12 cases while hi-level in 2 cases. The Bryan Cervical Disc prosthesis contains a proprietary, low-friction, wear-resistant, unmique polyurethane nucleus. The nucleus was articulated with shaped titanium plates （shells） that include convex porous ingrowth surfaces, to allow bony fixation to the adjacent vertebral endplates. The stabilization and range of motion at the implanted level were observe red on dynamic radiograph postoperatively. [ Result] The average follow up was 10 months and the longest follow up was 28 months. Neurological symptoms in all cases had significant improvement. The average improvement was 8.5 point according CSM criteria. Effective rate was 100%. There was no prosthesis displacement and loosening in all cases. The ROM at implant level was 6. 4 degrees on the flexion-extension radiographs. [ Conclusion] There is a definite stabilization and motion after implant of cervical dics prosthesis. A functional discs prosthesis is an effective treatment of cervical disc herniation. There is a good early clinical result. The result of long follow up should be observed further