Mobi-c人工颈椎间盘置换术治疗脊髓型颈椎病的临床疗效分析

Clinical Analysis of Mobi-c Prosthetic Disc in the Treatment of Cervical Spondylotic Myelopathy

目的:探讨人工颈椎间盘置换术用于治疗脊髓型颈椎病的临床疗效。方法:2008年6月～2010年9月,对18例保守治疗无效患者的22个节段进行了人工颈椎间盘置换术,男12例,女6例;年龄35～54岁,平均40±2.6岁。单节段14例,双节段4例,术后随访12个月～18个月,平均12.4±1.6个月。结果:所有患者伤口均1期临床愈合,术中及术后没有神经和血管损伤的并发症,结合术前术后颈椎活动范围检查、神经系统症状、JOA评分及影像学检查,置换节段稳定并部分恢复了颈椎正常的活动范围,患者神经系统症状均获得满意改善,JoA评分较术前明显升高,术后随访X线检查与术前比较生理弯曲改善,后凸生理弯曲纠正,人工颈椎间盘与上下终板紧密贴合,无假体松动,无失稳及脱位。CT及MRI结果未见脊髓及神经根重新受压,邻近节段椎间盘未见明显退变,未见易位骨化发生。结论:颈椎人工椎间盘手术操作简单,减压彻底,与颈椎前路椎间盘摘除植骨融合术最大的不同点是患者恢复快,没有颈椎活动受限的缺陷。脊髓及神经根受压明显解除,重建了满意的椎间隙高度及生理弯曲,并且更重要的是恢复了椎间关节的活动度。由于维持了正常的生物运动力学,可避免或防止邻近节段的退变,预期具有良好的远期疗效。

Objective： To reveal the clinical effect of the artificial cervical disc replacement in the treatment of Cervical Spondylotic Myelopathy.Methods：We have treated 18 patients（22 discs） with symptomatic cervical radiculopathy using method of cervical artificial disc replacement from June 2007 to Sept, of which 12 cases are male and 16 female with age from35 years to 54 years （mean 40 ± 2.6）. Single level disc was replaced in 14 cases while hi-level in 4 cases. Patients were followed-up for 12-18 months （mean12.4 ± 1.6）after operation. Results： All patients with uniform clinical wound healing, surgery and postoperative neurological and vascular injury without complications. Combined preoperative and postoperative range of cervical examination, neurologic symptoms, JOA score and radiological examination, replacement segments were stable and partially restored normal cervical range of activities, patient satisfaction with neurological symptoms were improved, JoA score significantly higher than before operation increased postoperative follow-up X-ray examination and improvement of preoperative physical bending, bending physiological kyphosis correction, artificial cervical disc and end plate tightly to the up and down with no prosthesis loosening, without failure, and dislocation. CT and MRI results of no re-compression of spinal cord and nerve roots, no significant adjacent segment disc degeneration, no translocation of ossification. Conclusion： The cervical artificial disc surgery is simple, complete decompression, and anterior cervical discectomy and fusion of the biggest differences is the rapid recovery of patients, no cervical defect with restricted mobility. Spinal cord and nerve root compression significantly lift the reconstruction of the intervertebral height and the satisfaction of physiological bending, and more importantly, to restore the intervertebral joint activity. Since maintaining the normal mechanics of biological movement can avoid or prevent the degeneration of adjacent segments, is expected to have good long-term effect.