Bryan颈椎人工椎间盘置换术后5年随访结果

Bryan cervical disc replacement,a five-year follow-up results

目的:观察Bryan颈椎人工椎间盘置换术后5年随访结果。方法:我院从2003年12月开展Bryan颈椎人工椎间盘置换术,术后达到5年的患者共70例,其中57例获得57～69个月(平均60个月)随访。单节段置换47例,双节段置换9例,3节段置换1例。C3/4 5例、C4/5 10例、C5/6 45例、C6/7 8例。术前和末次随访时进行mJOA、VAS、NDI评分,末次随访时进行Odom′s分级评估临床疗效;术前和末次随访时,在过伸过屈侧位X线片上测量置换节段活动度,在侧位X线片上采用McAfee异位骨化分级方法评定异位骨化情况,在MRIT2加权像上采用Miyazaki颈椎间盘退变分级方法评定相邻节段椎间盘退变情况,在MRI中矢状位T2加权像上测量相邻节段突出椎间盘对椎管的侵占率。结果:(1)mJOA评分术前为13.4±1.9分,末次随访时16.1±1.1分,平均改善率为75.0%;上肢痛VAS评分术前为3.3±1.9分,末次随访时0.9±1.2分;颈肩痛VAS评分术前为3.0±1.5分,末次随访时1.6±1.4分;NDI评分术前为14.8±8.6分,末次随访时5.7±4.2分;以上指标末次随访时与术前比较均有统计学差异(P<0.05)。末次随访时Odom′s分级优21例,良27例,可7例,差2例。(2)28例患者获得X线随访,术前置换节段活动度为6.9°±3.0°,末次随访时为7.2°±3.7°,无统计学差异(P>0.05);末次随访时,30个手术节段中12个(40%)出现异位骨化,其中3个(10%)节段丧失活动度。(3)25例患者获得MRI随访,末次随访时50个相邻节段中7个(14%)椎间盘退变分级加重1级,但无相关临床症状出现;相邻节段突出椎间盘对椎管侵占率的年度平均增幅为0.3%～0.5%。结论:Bryan颈椎人工椎间盘置换术后平均5年随访的临床和影像学结果满意,手术节段活动度得到较好保留,相邻节段退变发生率较低,无相邻节段疾病发生。

Objective：To investigate the five years′ follow-up outcomes of cervical arthroplasty with Bryan disc prosthesis.Method：70 patients have reached a postoperative period of 5 years since admission of this approach into our hospital in December 2003.57 patients obtained 57-69 months′（average,60 months） follow-up.There were 47 single-level,9 two-level and 1 three-level arthroplasties.The surgical levels included C3/4（5 cases）,C4/5（10 cases）,C5/6（45 cases） and C6/7（8 cases）.The clinical evaluation included mJOA,VAS and NDI score at pre-operation and final follow-up,Odom′s grading criteria at final follow-up.Radiographic evaluation included flexion/extension lateral view at operation level and heterotopic ossification around the prosthesis according to McAfee classification on lateral view X-ray.The adjacent segment degeneration was noted according to Miyazaki classification on MRI T2 weighted images.The invasion ratio of disc protrusion to the spinal canal at adjacent levels was recorded on mid-sagittal MRI T2 weighted images.Result：（1）The mJOA score was 13.4±1.9 of baseline and 16.1±1.1 at final follow-up.The improvement rate was 75.0%.The VAS for arm pain was 3.3±1.9 of baseline and 0.9±1.2 at final follow-up;the VAS for neck pain was 3.0±1.5 of baseline and 1.6±1.4 at final follow-up;the NDI score was 14.8±8.6 of baseline and 5.7±4.2 at final follow-up.All above-mentioned results showed statistical significance（P0.05）.According to Odom′s criteria,there were 21 excellent,27 good,7 fair and 2 poor at final follow-up.（2）28 patients obtained X-ray follow-up：ROM at operation level was 6.9°±3.0° of baseline and 7.2°±3.7° at final follow-up,which showed no statistical significance（P0.05）.The heterotopic ossification around the prosthesis was noted in 12 of 30（40%） segments,and 3（10%） segments lost movement at final follow-up.（3）25 patients gained MRI follow-up.7 of 50（14%） adjacent segments had nonsymptomatic disc degeneration to one grade.The invasion ratio of disc protrusion to the spinal canal at adjacent level increased 0.3%-0.5% every year.Conclusion：Cervical arthroplasty with Bryan disc prosthesis provides a favorable clinical and radiological outcome at an average of five years′ follow-up.The motion of operated level is well preserved.The prevalence of adjacent segment degeneration is low and no adjacent segment disease is noted.