人工颈椎间盘置换术治疗颈椎病的中期疗效观察

The mid-term results of cervical disc replacement for cervical spine myolopathy

目的:观察人工颈椎间盘置换术治疗颈椎病的中期临床效果。方法:2004年10月至2008年2月,对24例颈椎病患者共31个椎间隙行人工颈椎间盘置换术,其中脊髓型颈椎病21例28个椎间隙,神经根型颈椎病3例3个椎间隙;10例12个椎间隙应用Bryan假体,14例19个椎间隙应用Prodisc-C假体。术后随访24～65个月,平均39个月,定期对患者进行JOA评分和Oswestry颈椎功能障碍指数(ONDI)评定,并摄颈椎X线片测量置换节段及其相邻上下节段的活动度。结果:1例术后10个月手术节段椎体前缘骨质增生并融合,活动度丢失。其余患者随访期间置换节段稳定,颈椎生理弧度没有明显丢失;没有假体下沉和明显偏移;术后1个月、2年及末次随访时的JOA和ONDI评分与术前比较有统计学差异(P<0.01),术后各时间点两两比较无统计学差异(P>0.01)。术后1个月、2年及末次随访时置换节段及其相邻上下节段屈伸、左右侧屈活动度与术前比较无统计学差异(P>0.01),术后各时间点两两比较亦无统计学差异(P>0.01)。结论:人工颈椎间盘置换术后中期疗效满意,但仍然需要更长期随访结果来进一步评价其功能和对邻近节段的影响。

Objective：To investigate the mid-term clinical and radiological outcome of cervical disc replacement.Method：Twenty-four patients（31 discs） including 21 cases（28 discs） of spondylotic myelopathy and 3 cases（3 discs） of spondylotic radiculopathy undergoing artificial cervical disc replacement（12 Bryan discs and 19 Prodisc-C discs） from October 2004 to February 2008 were reviewed retrospectively.The follow-up was from 24 to 65 months with an averge of 39 months.X-ray,JOA score and Oswestry neck disability index（ONDI） were used to evaluate the outcome during following-up.Result：1 patient was noted to have bone bridging at anterior site of surgical segment which resulted in the loss of ROM 10 month later,while segment stability and cervical alignment were kept in other patients with no prosthesis subsidence and displacement.The postoperative JOA score and ONDI at 1 month and 2 years showed statistical significance（P0.01）compared with those of preoperative,but no statistical significance（P0.01） were noted between each postoperative time point.The postoperative flexion-extension and lateral bending ROM of either surgical segment or adjacent segments showed no difference with preoperative counterparts（P0.01）,and the same for each postoperative time points（P0.01）.Conclusion：It is a good mid-term outcome for artifical cervical disc replacement.At least 5 years of followed up time should be needed to assess the long term functionality of the prosthesis and the influence on adjacent levels.