人工颈椎间盘置换术治疗颈椎间盘退变的临床随访

Clinical follow-up after treatment of degenerative disc disease with Bryan cervical prosthesis replacement

目的随访人工颈椎间盘置换术治疗颈椎间盘退变性疾病对颈椎活动与维持手术节段稳定性的作用及临床效果。方法18例非手术治疗无效的颈椎病(脊髓型、神经根型/和混合型)行前路颈椎间盘切除后置入Bryan人工颈椎间盘,进行定期随访,根据手术前后颈椎的动力位X线片分析手术节段的稳定性。并结合病人神经症状和体征的改善情况评价其临床效果。结果手术效果优9例,良5例,一般3例,差1例。手术前平均JOA评分为12分,术后平均为15.5分;手术节段前屈后伸术前运动范围12.80±5.70,术后11.20±5.40;邻近间隙术前屈伸运动范围11.90±5.80,术后11.40±4.90。术前后比较P>0.05,无统计学差异。未发现假体松动和移位。结论人工颈椎间盘置换术安全可靠,病人恢复快,既可保持手术节段颈椎稳定,又可维持颈椎的生理活动度。

Objective The studies were designed to determine whether the Bryan disc prosthesis can provide relief from objective neurologic symptoms, and maintain stability and segmental motion. Methods 18 Cases （22 discs） with symptomatic cervical radiculopathy and/or myelopathy underwent implantation with the Bryan prosthesis after a standard anterior cervical discectomy. During scheduled follow-up periods, the effectiveness of the device was evaluated. Results JOA improved from average 12 grades preoperatively to 15.5 postoperatively. At follow-up,the dynamic radiographs showed that the flexion-extension range of motion averaged from preoperative 11.8±5.8 degrees to postoperative 11.2±5.4 degrees,and from 11.9±5.8 degrees to 11.4±4.9 degrees at the adjacent segment （p〉0. 05）. Conclusion Discectomy and implantation of the device alleviate neurologic symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports maintenance of motion. The procedure is safe and patients recover quickly. Longer time of follow-up will be needed to assess the long-term functionality of the prosthesis and protective influence on adjacent levels.