Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访

Clinical outcome of Bryan artificial cervical disc replacement for the treatment of cervical spondylosis:A midterm follow-up

背景:Bryan人工颈椎间盘置换的短期疗效优良已被大多数学者公认,但有关其中长期临床效果及并发症的资料较少。目的:总结Bryan人工颈椎间盘置换治疗颈椎病的中期临床效果。方法:选择2004-11/2007-12在四川大学华西医院骨科接受Bryan人工颈椎间盘置换的颈椎间盘突出症患者34例,其中单节段置换30例,双节段置换4例。于置换前、置换后7d、3,6,12,24,36,48个月行SF-36生活质量量表评分、JOA评分、颈部及上肢疼痛目测类比评分;以颈椎正侧位及功能位X射线片测量手术节段、邻近节段及C2～7屈伸活动度的变化,手术节段和邻近节段椎间高度变化及手术节段的轴向平移情况。结果与结论:所有患者置换后神经症状均明显好转,各随访点SF-36生活质量量表躯体评分和心理评分、JOA评分、颈部和上肢疼痛目测类比评分较置换前明显改善(P<0.05),3个月之后各随访时点两两比较差异无显著性意义(P>0.05)。置入的Bryan假体历次随访均保留了>2°的活动度,未发现手术节段异位骨化与自发性融合,随访48个月时手术节段及C2～7屈伸活动度较置换前略有增加,但差异无显著性意义(P>0.05);上下邻近节段屈伸活动度维持了置换前水平;手术节段的椎间高度由置换前的(6.04±1.02)mm增加到(8.44±0.43)mm(P<0.05);上下邻近节段椎间高度及手术节段的轴向平移均维持了置换前水平。说明Bryan人工颈椎间盘治疗颈椎间盘退变性疾病的中期临床效果良好,较好的保留了手术节段、邻近节段及整个颈椎的运动学特性,且近中期并发症很少。

BACKGROUND：Although the short-term clinical efficacy of Bryan artificial cervical disc replacement is generally acknowledged by most spinal surgeons,the midterm and long term clinical results and complications are still unclear.OBJECTIVE：To summarize midterm term clinical results of Bryan artificial cervical disc replacement for the treatment of cervical spondylosis.METHOD：From November 2004 to December 2007,34 patients had Bryan cervical disc replacement in Department of Orthopedics,West China Hospital were selected,including 30 cases with single replacement and 4 cases with bi-level replacement.Clinical result was evaluated by SF-36 score,JOA score,and neck/arm pain VAS scores.And the data was collected before surgery and at 7 days,3,6,12,24,36 and 48 months after surgery.Neutral lateral and dynamic cervical radiographs were made to measure the flexion-extension range of motion（ROM） of operative segment,adjacent segments and C2-7 segment,the intervertebral height of operative and adjacent segments,and the translation of operative level.The intraoperative and postoperative complications were recorded and analyzed.RESULTS AND CONCLUSION：The neurological symptoms of each patient were alleviated notably.The postoperative SF-36 physical component score and SF-36 mental component score,JOA score,NDI score and neck/arm pain VAS scores were significantly improved compared with those of the preoperative（P 0.05）,but no statistical significance were noted between each time point after 3-month follow-up（P 0.05）.Each implanted prosthesis preserved the ROM2 at each follow-up time point,and no heterotopic ossification or spontaneous fusion was found at the operative segment.At 48-month follow-up,flexion-extension ROM of operative segment and C2-7 segment slightly increased but showed no statistical significance compared with the preoperative counterparts（P 0.05）;ROM of upper and lower adjacent segments also showed no statistical significance compared with the preoperative data（P 0.05）.Intervertebral height of operative segment was（6.041.02） mm before the operation and significantly increased to（8.440.43） mm at 48-month follow-up（P 0.05）.Intervertebral height of adjacent segments,and the translation of operative level were not significantly changed（P 0.05）.The clinical result of Bryan artificial cervical disc replacement is good and kinematic characteristics of operative segment,adjacent segments and C2-7 segment can be maintained in midterm follow-up.The operation is safe and there are few early midterm complications.