Bryan人工颈椎间盘置换术治疗颈椎病早中期疗效观察

Intermediate observation of motion range follow-up after treatment of degenerative disc disease with the Bryan cervical disc prosthesis

[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，提高患者的生活质量，并保持颈椎稳定和节段活动。[方法]对19例23个椎间盘的人工颈椎间盘置换术进行了随访。随诊时间：8～76个月，平均29个月。其中脊髓型颈椎病15例，其他4例。男12例，女7例；年龄35～52岁，平均40．5岁。单节段置换16例，双节段2例，3节段1例。[结果]术中或术后没有神经和血管损伤的并发症。JOA评分从平均8．6分增加到15．8分。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2／23节段的假体偏移〈1．5mm。颈椎的生理弧度没有明显的丢失。置换节段假体周围没有骨化。[结论]19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点是患者恢复快，没有颈椎活动受限的缺陷。但至少需要5年的长期随访来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 patients ability to perform activities of daily living, decrease pain, and maintain stability and segmental motion. [Method] Nine cases were followed up, 23 discs of cervical artifical disc replacement were operated from December 2003 to October 2004. The follow-up time ranged from 8 to 76 months, averge 29 months. There were cervical spendylotic myelopathy in 4 cases. Cervical disc herniation were 15 cases. Males 12 cases, females 7 cases. Age from 35 to 52 years old, averge 40. 5 years. Single-level 16 cases, bi-level 2 cases, three level 1 case. [ Result] No neurological or vascular complication was found during or after surgery. JOA score increased from averaged 8.6 to 15.8. There was no prosthesis subsidence or excursion. Replaced segment achived stability and restored partial of normal ROM, 4. 68° （3.6°- 6. 1°） in flextion and extension position and 3.51° （2. 5°-4. 6°）, 3.42°（2. 6°-4. 3°） in left and right bending position. No obvious loss of lordosis was found. CT or MRI follow-up showed excursion （ 〈 1.5 mm） in 2/23 levels; and no ossification in the replaced levels. [ Conclusion] It is a good early outcome for 19 cases artifical disc replacement. Discectomy and implantation of the device alleviates neurologic symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports maintenance of motion. The procedure is safe and the patients recover quickly. At least 5 years of follow-up will be needed to assess the long-term function of the prosthesis and protective influence on adjacent levels.