多件式人工颈椎间盘置换在神经根型颈椎病中的应用及疗效观察

The application of cervical arthroplasty with Mobi-C for treatment of cervicalspondylotic radiculopathy

目的探讨前路人工颈椎间盘置换术治疗神经根型颈椎病的临床疗效。方法2008年3月至2009年11月，共67例神经根型颈椎病患者采用Mobi—C人工颈椎间盘假体行颈前路人工问盘置换术，术后3d、3、6个月、1年及以上进行随访观察，采用SF-36健康调查评分（SF-36）及疼痛视觉模拟评分（VAS）评估临床疗效。术前及术后行颈椎正侧位及动力位X线片检查观察手术节段的椎间高度、活动度（ROM）和异位骨化的情况。结果67例患者，随访51例，失访16例，随访时间13—31个月，平均19．7个月。所有患者临床症状均明显改善，术前及术后SF-36评分6个维度及VAS评分差异均具有统计学意义（P〈0．05）。VAS颈痛由术前4．6±0．4减少至术后的2．0±0．5，VAS臂痛由术前6．5±0．4降低至术后的1．3±0．4。椎间隙高度术前为（6．5±1．1）mm，末次复查为（7．7±0．9）mm，两者间差异具有统计学意义（P〈0．05）。手术节段ROM术前为7．2。±3．1。，术后末次随访为8．1°±3．2°，两者间差异无统计学意义（P〉0．05）。24例（47．0％）患者术后1年出现手术节段异位骨化（McAfeeI级17例，Ⅱ级7例），但无相应临床症状，未见其他手术相关并发症发生。结论人工颈椎间盘置换术治疗神经根型颈椎病能有效的改善神经功能及临床症状，并可维持颈椎活动度、恢复椎间高度和颈椎生理弧度，近期疗效满意。

Objective To investigate the clinical effectiveness of cervical arthroplasty with Mobi-C prosthesis for treatment of cervicalspondylotic radiculopathy. Methods From March 2008 to November 2009, a group of 67 patients with cervical spondylotic radiculopathy were analyzed retrospectively. The short form-36 physical component summary （SF-36） and visual analogue scale （VAS） score were used to compare clinical outcome pre- and postoperatively. The follow-up was performed at 3 d, 3 months, 6 months and 1 year postoperatively. Static and dynamic radiography were taken to evaluate height of disc space, range of motion （ROM） and heterotopic ossification（HO） of index levels. Results Fifty-one cases were followed up, 16 cases were lost. Average follow-up was for 19.7 months（ 13-31 months）. All of patients had improvement for clinical symptoms. There was a significant difference on SF-36 between pre- and postoperatively. The significant difference was found in VAS score in which neck pain was decreased from preoperative 4. 6 ±0. 4 to postoperative 2. 0 ± 0. 5 （ P 〈 0. 05 ）, arm pain was decreased from preoperative 6. 5 ±0.4 to postoperative 1.3 ±0. 4 （P 〈 0. 05）. There was a significant difference in height of disc space which was increased from preoperative （6. 5 ± 1.1 ）mm to（7.7 ±0. 9）mm （P 〈0. 05） . ROM was increased from preoperative 7.2° ± 3. 1°to latest follow-up 8. 1 ° ±3.2°, however, no significant difference was found concerning ROM pre- and postoperatively（ P 〉 0. 05）. No other complications were met during follow-up period other than the 17 cases of heterotopic ossification in Class I , the 7 cases in Class Ⅱ in 1 year postoperatively, but no any correlation were found between the radiographic finding in HO and clinical symptoms. Conclusions Cervical arthroplasty with Mobi-C could improve neurofunctional symptoms, maintain ROM of index level and height of disc space. For accurate patient selection, long term follow-up is still needed in prospective randomizedstudy.