Bryan人工椎间盘置换术治疗颈椎病的近期临床效果及出现的问题

The short term outcome of Bryan artificial disc replacement and some related issues

目的:总结近3年应用Bryan人工椎间盘置换术治疗颈椎病的疗效,分析容易出现的问题,探讨其原因及相关对策。方法:回顾性分析121例应用Bryan人工椎间盘置换术治疗的颈椎病患者,共145个置换节段,其中单节段99例,双节段20例,三个节段2例。应用JOA17分法评价术前和末次随访时的神经功能状况。观察末次随访时颈椎侧位X线片上假体的前后径与椎体前后径的差异,假体上下终板的相互位置关系,假体轴线与原来椎间隙轴线的对应关系。在颈椎过伸过屈侧位X线片上观察假体上下终板间的活动以及假体前后缘有无钙化或骨化。结果:随访12￣24个月,平均18个月,脊髓型颈椎病患者的平均JOA评分由术前平均8.5分增加到术后平均15.5分,神经根型颈椎病患者的症状完全消失。未见假体松动、移位以及症状加重者。有42个假体(28.97%)的前后径小于椎体的前后径;颈椎中立位时有23个假体(15.86%)的上下终板的前缘或者后缘过于接近,影响置换节段的前屈或后伸;有32个假体(22.07%)的轴线与原有椎间隙的轴线不一致,向头侧或尾侧旋转。上述问题绝大部分出现在开展此手术早期的病例。3例共4个置换假体(2.76%)在术后1年内出现假体周围融合,2例在椎体的前缘,1例在椎体的后缘。结论:Bryan人工椎间盘置换术治疗颈椎病近期临床效果良好,但实施该手术需要经历一定的学习曲线,应当重视出现的相关问题,缩短学习曲线。

Objective：To review the clinical outcome of Bryan artificial disc replacement in the treatment of cervical disc disorders （CDD）,and investigate the cause of some technical problems and their possible solutions.Method：121 cases of CDD with 145 Bryan disc replacement including 99 cases of single-level,20 cases of double-level and 2 cases of three-level were reviewed.JOA 17 score scale was used for the neurological assessment of pre-operation and final follow up.The lateral view X-rays of the cervical spine at final follow up were evaluated for the difference of AP diameter between implant and vertebral body（VB）,the position of superior and inferior implant endplate,and the axis of implant and original disc space.The motion of implant and heterotopic ossification around the implants were recorded on the flexion and extension lateral view X-rays.Result：All cases obtained the follow-up with an average of 18 months （range 12 to 24 months）. The pre-operative JOA score was 8.5 and post-operative one was 15.5 on an average in the cases of spondylotic myelopathy.All symptoms disappeared in the cases of radiculopathy.There was no subsidence of implant and worsening of pre-operative symptoms.42 disc implants （28.97%） had smaller size than the endplate of VB.23 artificial discs （15.86%） had their superior and inferior implant endplate too close each other at either anterior or posterior edge when the neck was in neutral position,which resulted in the limited flexion and extension of implanted segment.32 implants（22.07%） had their implant axis rotated superiorly or inferiorly.4 discs of 3 cases （2.76%） had spontaneous fusion happened within 12 months after operation.Two cases fused at anterior edge of VB and one at the posterior edge.Conclusion：The Bryan cervical disc replacement for the treatment of cervical disc disorders （CDD） has offered an excellent short term clinical outcome.This technique does require certain learning curve.Some related issues need to be addressed to shorten the learning curve.