Bryan人工颈椎间盘对颈椎整体及置换节段曲度影响的中期观察

The mid-term effects of Bryan cervical disc prosthesis on sagital alignment of overall cervical spine and the functional spinal unit

目的观察Bryan人工颈椎间盘置换术后颈椎整体中立位C2-7，曲度及置换节段曲度变化。方法2005年11月至2010年5月，对18例颈椎病患者施行了20个Bryan人工颈椎间盘置换术。患者中男性13例，女性5例，年龄38-59岁，平均（47±6）岁。其中单节段置换16例，双节段2例。14例患者术前C2-7，曲度存在生理性前凸同时置换节段曲度前凸（前凸组），4例术前C2-7，曲度存在后凸同时置换节段曲度后凸（后凸组）。统计并分析患者术前、术后及末次随访时颈椎整体中立位C2-7，曲度及手术节段曲度变化。结果术后随访12-53个月，平均（24±5）个月。前凸组术前C2-7。曲度平均为9．9°±1．9°、术后平均12．8°±2．1°、末次随访时平均11．6°±1．8°；后凸组术前C2-7曲度平均-1．8°±0．8°、术后平均7．3°±1．3°、末次随访时平均5．0°±2．1°，两组术前与术后比较差异均有统计学意义（t=-2．987和-5．058，P〈0．05），两组术后与末次随访之间曲度变化差异均无统计学意义（P〉0．05）；前凸组置换节段曲度术前平均为2．6°±0．8°、术后平均5．4°±1．0°、末次随访时平均4．3°±0．9°，后凸组术前置换节段曲度平均-3．0°±0．8°、术后平均3．8°±1．3°、末次随访时平均0．3°±2．8°，前凸组及后凸组术前与术后比较，差异均有统计学意义（t=-3．829和-4．086，P〈0．05）；前凸组术后与末次随访间差异有统计学意义（t=2．630，P〈0．05），后凸组术后与末次随访间差异无统计学意义（P〉0．05）。结论Bryan人工颈椎间盘置换术后能有效地维持或改善颈椎中立位及手术节段曲度，但仍需更长时间的随访来评估其远期影响。

Objective To investigate the mid-term radiological outcome of sagital alignment of overall cervical spine and the functional spinal unit after replacement surgery with Bryan cervical disc prosthesis. Methods Eighteen patients with cervical disc disorder were performed cervical disc replacement with 20 Bryan discs from November 2005 to May 2010, including single-level 16 cases and hi-level 2 cases. The patient consisted of 13 males and 5 females with age ranging from 38 to 59 years （average, （47 ± 6） years）. Fourteen cases with overall cervical lordotic alignment and segmental lordotic alignment peroperatively （ group 1 ） and 4 others with segmental kyphotic alignment and overall cervical kyphotic alignment per-operatlvely （group 2 ）. The overall sagital alignment （C2_7 ） and segmental sagital alignment were measured pre-operatively, post-operatively and at final follow-up to evaluate the outcome. Results All cases obtained the follow-up with an average of （24 ± 5 ）months （range 12 to 53 months） . To the mean overall cervical alignment , there were 9.9° ± 1.9° per-operatively, 12.8°± 2. 1° post-operatively and 11.6° ± 1.8° at final follow-up in group 1 and - 1.8° ±0. 8° per-operatively,7. 3° ± 1.3° post-operatively and 5.0° ± 2. 1°at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively（ t = - 2. 987 and - 5. 058, P 〈 0. 05 ） and no statistical significance between post- operatively and final follow-up （ P 〉 0. 05 ） in both groups. To the mean segmental alignment there were 2, 6° ±0. 8° per-operatively, 5.4°± 1. 0°post-operatively and 4. 3° ±0. 9°at final follow-up in group 1 and -3.0°±0. 8° per-operatively,3.8° ± 1.3° post-operatively and 0. 3° ± 2. 8° at final follow-up in group2. There were statistical significance between per-operatively and post-operatively in both groups （ t = - 3. 829 and - 4. 086, P 〈 0. 05 ） and between post-operatively and final follow-up in group 1 （ t = 2. 630, P 〈 0. 05 ） but not in group 2 （ P 〉 0. 05 ）. Conclusions The Bryan cervical disc prosthesis has a good mid-term outcome for maintaining sagital alignment of overall cervical spine and the functional spinal unit. Long-term follow-up should be needed to assess the long-term functionality of the prosthesis.