12例颈椎人工椎间盘置换治疗单、双节段颈椎病的初期临床疗效评价

Appraisement of initialclinical efficacy of treatment of cervical spondylotic with artificial cervical disc prosthsis replacement in 12 cases

目的:探讨12例颈椎人工间盘置换治疗颈椎病的初期临床疗效。方法:回顾性分析重庆医科大学附属第一医院骨科2007年7月～2010年3月行颈椎人工椎间盘置换术(Artificial cervical disc prosthsis replacement,ACDR)的颈椎病患者12例,其中脊髓型颈椎病8例,神经根型颈椎病4例;病变节段:单节段9例,双节段3例;其中C4～5 2例,C5～6 6例,C6～7 1例,C4～5合并C5～6 2例,C5～6合并C6～7 1例。患者术前与术后3个月均行颈椎正侧位、过伸过屈侧位X线片,对其进行Odom标准疗效评价、日本骨科协会(Japanese orthopedics,JOA)评分、置换节段活动度(Range of motion,ROM)的测量,评定本组患者初步疗效。结果:经3～31个月随访,采用Odom临床疗效评定标准J:OA优9例,良好3例;评分由术前平均8.5分(6～13分)增加至术后第3个月平均15.6分(13～17分);术后3个月置换节段前屈、后伸活动范围平均5.2°(4.4°～6.3°),左、右侧屈活动范围分别为平均3.4°(2.8°～4.3°)和3.5°(3.0°～4.3°)。12例患者术后未出现神经和血管损伤的并发症。末次随访X线示椎间高度、颈椎稳定性均维持良好,未发现置换节段异位骨化、假体偏移、松动或下沉等并发症。结论:颈椎人工椎间盘置换选择性治疗颈椎病的初期临床和影像学结果令人满意,但仍需远期随访结果评价此技术的有效性。

Objective：To probe initial clinical efficacy of treatment of cervical spondylosis with artificial cervical disc prosthsis replacement in 12 cases.Methods：12 cases were treated by artificial cervical disc prosthsis replacement in the first affiliated hospital of Chongqing medical university between July 2007 and March 2010,including 8 cases with cervical spondylotic myelopathy and 4 cases with cervical spondylotic radiculopathy.In the 12 cases,the pathological segments included one level segment in 9 cases and two level segments in 3 cases with 2 cases at C4～5,6 cases at C5～6,1 case at C6～7 and 2 cases at both C4～5 and C5～6,1 case at both C5～6 and C6～7.Clinical and radiological（X-ray of anteroposterior and lateral,bending and extending positions）study before and 3 months later after operation in all cases were performed in order to give a overall appraisal about the stability of implanted prosthsis.Results：The follow-up was performed during 3～31 months in 12 cases,and the results of operation were excellent in 9 patients and good in 3 patients according to the Odom＇criteria.JOA score increased from the average of 8.5（6～13,before operation） to 15.6（13～17,3 months after operation）.The range of motion of operative segment was 5.2°（4.4°～6.3°） in flextion and extension position and 3.4°（2.8°～4.3°）,3.5°（3.0°～4.3°） in left and right bending position at 3 months after operation.No neurological or vascular complication was found in all 12 cases.The X-ray of all cases demonstrated satisfactory height and stability of the cervical vertebra and no complication such as ectopic ossifications of operative segment,prosthesis excursion,loosen or subsidence were found in the last follow-up.Conclusion：Artificial cervical disc replacement as a selective therapy to cure cervical spondylosis is satisfactory both in clinical efficacy and imageology.Although the early results are promising,long-term follow-up studies are still required to prove its efficacy.