影响Bryan人工颈椎间盘置换术后置换节段活动度的因素

Factors affecting segmental range of motion after single level Bryan disc replacement

目的:观察Bryan人工椎间盘置换术后置换节段活动度变化情况,分析影响术后活动度的原因。方法:回顾分析2003年12月～2007年6月在我院行单节段Bryan人工颈椎间盘置换术的57例患者,所有患者手术前后均行正侧位和伸屈位X线检查,分析术前拟置换节段椎间隙高度和活动度、拟置换节段脊柱功能单位(FSU)与上位椎体高度比值和FSU后凸角度与术后置换节段活动度的关系。结果:(1)术前拟置换节段椎间隙高度与邻近节段椎间隙高度比值<0.8的患者术后置换节段活动度平均为7.1°,≥0.8的患者平均为9.2°,经统计学比较有显著性差异(P<0.05);(2)术前拟置换节段活动度<6°的患者术后活动度平均为6.8°,≥6°的患者平均为9.7°,经统计学比较有显著性差异(P<0.05);(3)术后置换节段FSU与上位椎体高度比值下降≥0.05的患者术后活动度平均增加0.19°,<0.05的患者平均增加2.13°,经统计学比较有显著性差异(P<0.05);(4)术后FSU后凸角度增加者活动度平均增加0.73°,后凸角度无增加者活动度平均增加1.90°,经统计学比较无显著性差异(P>0.05)。结论:人工椎间盘置换术后FSU高度下降影响术后置换节段活动度,术前病变节段椎间隙高度丢失>20%和(或)屈伸活动度之和<6°者不适合行Bryan人工颈椎间盘置换术。

Objectlve：To investigate factors affecting the range of motion （ROM） of operative level after Bryan disc replacement.Method：57 cases with single level Bryan disc replacement in one center from December 2003 to June 2007 were reviewed.On dynamic X-rays, ROM of operative level,height ratio of operative disc and adjacent discs,height ratio of FSU and upper vertebral body,and FSU angle were measured and analyzed.Result：The postoperative segmental ROM of the height ratio of operative disc and adjacent discs 〈0.8 group averaged 7.1° ,and postoperative segmental ROM of height ratio ≥0.8 group averaged 9.2° with statistical significance.The postoperative segmental ROM of preoperative BOM 〈6° group averaged 6.8° ,and preoperative ROM ≥6° group averaged 9.7° with statistical significance.The postoperative segmental ROM of FSU decreased group （preoperative height ratio of FSU and upper vertebral body-postoperative ratio ≥0.05） increased 0.19°,and FSU without change group （preoperative height ratio of FSU and upper vertebral body- postoperative ratio 〈0.05） increased 2.13° with statistical significance.The postoperative segmental ROM of FSU kyphosis group increased 0.73°,and FSU without change group increased 1.90° without statistical significance.Conclusion：Decreased FSU height after Bryan disc replacements lead to decreased ROM of operative level.Cases with a loss of preoperative disc height more than 20% and （or） cases with preoperative ROM of operative level 〈6° are not best indication for Bryan disc replacement.