Bryan人工颈椎间盘置换术后异位骨化形成的临床因素分析

Risk factors associated with heterotopic ossification following Bryan disc replacement:a retrospective study

目的:分析Bryan人工颈椎间盘置换术后异位骨化形成的临床相关因素。方法:回顾分析我院自2003年12月至2007年1月接受单节段Bryan人工颈椎间盘置换术的51例患者,使用Logistic回归分析术前病变节段椎间隙前方纤维环或前纵韧带钙化或骨化情况,术前病变节段椎间隙高度,围手术期非甾体类抗炎药(NSAIDs)、激素的使用情况,术中出血量,术前、术后置换节段活动度以及手术前后脊柱功能单位(functionalspine unit,FSU)高度变化等因素与异位骨化形成的关系;并分析置换节段术后不同活动度(≤6°及>6°)与异位骨化形成的关系。结果:本组中单节段Bryan人工颈椎间盘置换术后17例发生异位骨化,发生率为33.3%。所研究的相关因素中,仅术前病变节段椎间隙高度与相邻节段椎间隙高度的比值、术后手术节段活动度两项与术后异位骨化的形成具有显著相关性(P<0.05)。所有患者术前病变节段椎间隙高度与相邻节段椎间隙高度比值的平均值为0.86,出现异位骨化组的平均值为0.80。置换节段活动度术前平均7.6°,术后平均8.8°,术后异位骨化形成与术后置换节段活动度减少程度有关。术后置换节段活动度≤6°者11例,其中8例出现异位骨化形成;术后置换节段活动度>6°者40例,其中9例发生异位骨化形成,两组间具有显著性差异(P<0.05)。结论:术前病变节段椎间隙高度、术后手术节段活动度与术后异位骨化形成有关,术前节段椎间隙高度丢失>20%者不适合行Bryan人工椎间盘置换术。

Objective：To identify the clinical factors associated with the occurrence of heterotopic ossification （HO） following Bryan disc replacement.Method：51 patients undergoing single level Bryan disc replacement from December 2003 to January 2007 were reviewed retrospectively.Eight clinical factors including the calcification or ossification of anterior portion of annular fibrosis and anterior longitudinal ligament and the disc height of target level,perioperative use of NSAIDs and steroids,intraoperative bleeding,pre- and post-operative ROM and alteration ratio of functional spine unit （FSU） were examined.The correlation between these eight clinical factors and the occurrence of postoperative HO was evaluated with logistic regression analysis.The relationship between different postoperative ROM of target level （≤6° or 〉6°） and HO was examined by Crosstab Chi-squared test.Result：The occurrence rate of HO in this study was 33.3%.Only two clinical factors including the ratio of preoperative diseased disc height and its adjacent disc height as well as postoperative ROM of target level presented statistical correlation（P〈0.05） with HO,The mean value of the preoperative disc height ratio of the target level and its adjacent level was 0.86,and particularly,in patients with HO,the mean value was 0.80.ROM of the target level increased from 7.6° preoperatively to 8.8° postoperatively and the occurrence of HO was associated with the extent of ROM decrease at target level postoperatively （P〈0.05）, especially for those no more than 6°,8 of ll cases had heterotopic ossification,while for those larger than 6° ,9 of 40 cases had HO which showed statistical significance （P〈0.05）.Conelusion：Preoperative disc height and postoperative ROM of diseased level is correlative with the occurrence of postoperative HO,for those with disc height loss exceeding 20% ,it is not indicated for Bryan disc replacement.