Bryan人工颈椎间盘置换与颈前路椎间融合术后轴性症状的对比分析

CONTRASTIVE ANALYSIS OF NECK AXIAL SYMPTOMS AFTER BRYAN CERVICAL DISC ARTHROPLASTY OR TRADITIONAL ANTERIOR CERVICAL DISCECTOMY AND FUSION

目的探讨Bryan人工颈椎间盘置换术与颈前路椎间融合术后颈部轴性症状(axial symptom,AS)的发生,并进行对比分析。方法2004年10月-2006年4月,对22例患者行Bryan人工颈椎间盘置换术(A组),男13例,女9例;年龄33～54岁,平均43.3岁。病程1～21个月,平均6个月。其中脊髓型颈椎病16例,神经根型颈椎病6例。单节段置换20例,2个节段置换2例。对同期30例患者行颈前路椎间盘切除减压植骨融合内固定术(B组),男17例,女13例;年龄35～64岁,平均50.3岁。病程1～23个月,平均7个月。其中脊髓型颈椎病19例,神经根型颈椎病11例。单节段融合26例,2个节段融合4例。观察两组患者术后随访时神经功能恢复情况,手术节段颈椎曲度、颈椎总活动度(range of motion,ROM)的变化情况及颈部AS的发生情况,并进行比较分析。结果两组患者术中、术后均无严重并发症发生。所有患者均获随访,随访时间24～42个月,平均30.6个月。A组术后无假体移位、脱落等并发症发生;B组术后6个月X线片示植骨全部达骨性融合,内固定无松动、脱落、断裂等。两组神经根型患者术后随访时临床症状均明显缓解,疗效满意。两组脊髓型患者JOA评分术后随访时均较术前有明显提高(P<0.01);两组术前及随访期末差异均无统计学意义(P>0.05)。B组术后手术节段颈椎后凸发生率明显增高,且高于A组(P<0.05)。B组ROM较术前明显减小(P<0.01),A组手术前后差异无统计学意义(P>0.05);两组术后差异有统计学意义(P<0.05)。术后颈部AS发生率A组为18.18%,B组为46.67%,两组比较差异有统计学意义(P<0.05)。结论与前路融合手术相比,Bryan人工颈椎间盘置换治疗颈椎病在取得良好临床疗效的同时能维持手术节段ROM及曲度,避免ROM的减少及术后颈部AS的发生。

Objective To explore the neck axial symptom （AS） after Bryan cervical disc arthroplasty traditional anterior cervical discectomy and fusion, and to make contrastive analysis. Methods From October 2004 to April 2006, 22 patients, 13 males and 9 females, aged 33-54 years old （43.3 on average）, underwent Bryan cervical disc placement （group A）. Among them, there were 16 cases of cervical spondylotic myelopathy and 6 of nerve root cervical syndrome, with 20 of single segment replacement and 2 of two segments replacement. The courses of disease were 1-21 months （6 months on average）. Meanwhile, 30 patients, 17 males and 13 females, aged 35-64 years old （50.3 on average） underwent traditional anterior cervical discectomy and fusion （group B）. Among them, there were 19 cases of cervical spondylotic myelopathy and 11 of nerve root cervical syndrome, with 26 of single segments replacement and 4 of two segments replacement. The course of disease was 1-23 months （7 months on average）. In both groups, the neurologic recovery rate, the change of cervical curvature of the operated segments and total range of motion （ROM）, and incidence of neck axial symptoms were recorded and compared. Results All the patients were followed up for 24-42 months （30.6 months on average）. There was no graveness complication happening during and after operation in both groups. There were no complications of prosthesis bit shifting and amotio in group A, and group B exhibited a bony fusion on X-ray films 6 months after operation, without plate and bolt loose or broken. The patients＇ clinical symptoms of radiculopathy were obviously relieved and the curative effect was satisfactory in two groups of nerve root cervical syndrome. In both groups of cervical spondylotic myelopathy, the patients＇ JOA scores at the postoperative follow-up increased obviously than preoperative （P 〈 0.01）, and there was no significant difference between the two groups before the operation and at the end of the follow-up （P 〉 0.05）. The rate of sagittal alignment of the operated segment with kyphosis increased obviously in group B, higher than in group A （P 〈 0.05）.The total ROM of group B was obviously lower than preoperative （P 〈 0.01）, and the pre-and postoperative difference of group A was not statistically significant （P 〉 0.05）. The rate of postoperative neck AS was 18.18% in group A and 46.67% in group B, and the difference was statistically significant （P 〈 0.05）. Conclusion Compared with traditional anterior cervical discectomy and fusion, the use of Byran disc arthroplasty for cervical syndrome is associated with good outcomes. At the same time, it can maintain the cervical motion and curvature of operated segments, avoid the decrease of total ROM and lower the incidence of the postoperative neck AS.