双节段颈椎病人工椎间盘置换术的临床疗效分析

CLINICAL EFFECT OF CERVICAL ARTIFICIAL DISC REPLACEMENT ON TWO-SEGMENT CERVICAL SPONDYLOSIS

目的探讨人工颈椎间盘置换术(cervical artificial disc replacement,CADR)治疗双节段颈椎病的临床疗效及对病变节段及其邻近上、下节段活动度的影响。方法2004年9月-2007年2月,采用BryanDisc假体行CADR治疗C4、5、C5、6双节段颈椎病7例。男4例,女3例;年龄30～45岁,平均38.5岁。患者均有不同程度颈痛、肢体疼痛麻木、肌力下降。病程12～54个月,平均27个月。其中神经根型、脊髓型各3例,混合型1例。术前X线片检查示均存在不同程度C4、5、C5、6椎间隙狭窄及颈椎曲度变直,CT或MRI显示C4、5、C5、6椎间盘不同程度突出、椎体边缘骨质增生压迫神经根或脊髓。所有患者术前均经系统保守治疗无效。对患者术前和术后随访时JOA评分和病变节段及其邻近上、下节段的活动度进行比较。结果所有患者均安全度过围手术期,无声音嘶哑、肌肉痉挛、吞咽困难、颈部疼痛。术后12个月X线片示Bryan Disc人工椎间盘假体位置良好,椎间隙高度维持正常,无假体松动、移位及感染征象发生。7例均获随访,随访时间12～41个月,平均26.7个月。颈痛、肢体疼痛麻木均消失、肌力明显改善。术前JOA评分为(8.35±1.27)分,术后随访时为(14.65±1.61)分,差异有统计学意义(P<0.05)。术前病变节段(C4、5)和(C5、6)活动度分别为(8.38±0.48)°和(9.16±0.54)°,术后随访时分别为(11.15±0.65)°和(12.75±0.73)°,与术前比较差异有统计学意义(P<0.05)。术前邻近上位(C3、4)和下位(C6、7)节段活动度分别为(9.71±0.76)°和(12.39±0.58)°,术后随访时分别为(10.26±0.47)°和(13.67±0.71)°,与术前比较差异无统计学意义(P>0.05)。结论BryanDiscCADR治疗双节段颈椎病可获满意疗效,病变节段活动度明显改善,且对邻近上、下节段活动度影响小。

Objective To investigate the cl inical effect of cervical artificial disc replacement （CADR） on twosegment cervical spondylosis and to research its influences on the range of motion （ROM） of the diseased segments and the adjacent superior and inferior segments. Methods From September 2004 to February 2007, 7 cases with cervical spondylosis at C4,5 and C5,6 were treated with CADR using Bryan artificial disc prosthesis, including 4 males and 3 females aged 30-45 years old （average 38.5 years old）. All the patients had cervicodynia in various degrees, pain and numbness of l imbs and decreased muscle strength, including 3 cases of cervical spondylotic radiculopathy, 3 of cervical spondylotic myelopathy and 1 of mixed cervical spondylosis. The course of disease was 12-54 months （average 27 months）. Preoperatively, X-ray films revealed the intervertebral space of C4, 5 and C5,6 was narrowed and the cervical curve became straight, CT or MRI showed the intervertebral disk hernia of C4, 5 and C5,6, and the hyperostosis of vertebral margin compressed nerve root or spinal cord. All the patients had no response to the preopratively conservative treatment. JOA score and ROM of the diseased segments and the adjacent superior and inferior segments were compared before and after operation. Results All the patients survived the perioperative period, without hoarse voice, muscle spasm, dysphagia and cervicodynia. X-ray films showed the implanted prosthesis was well located, the height of intervertebral space was normal, and no prosthesis loosening, prosthesis migration and infection occurred 12 months after operation. All the 7 cases were followed up for 12-41 months （average 26.7 months）. Cervicodynia and l imbs＇ pain and numbness disappeared, and muscle strength was improved obviously. The JOA score before and during the followup period was （8.35 ± 1.27） and （14.65 ± 1.61） points, respectively, indicating there was a significant difference （P 〈 0.05）. For the ROM of C4,5 and C5,6, it was （8.38 ± 0.48）° and （9.16 ± 0.54）° before operation, respectively, and it increased to （11.15 ± 0.65）° and （12.75 ± 0.73）° after operation, respectively, showing there was a significant difference （P 〈 0.05）. The ROM at C3,4 and C6,7 before operation was （9.71 ± 0.76）° and （12.39 ± 0.58）°, espectively, while it was improved to （10.26 ± 0.47）° and （13.67 ± 0.71）° after operation, respectively, indicating there were no significant differences between before and after operation （P 〉 0.05）. Conclusion The appl ication of Bryan Disc CADR for two-segment cervical spondylosis has satisfying therapeutic effects, can improve the ROM of diseased segments obviously, and has minor influences on the ROM of adjacent superior and inferior segment.