颈椎间盘置换治疗脊髓型颈椎病的疗效观察

EFFECTIVENESS OF CERVICAL DISC REPLACEMENT FOR CERVICAL MYELOPATHY

目的探讨颈椎间盘置换治疗脊髓型颈椎病的疗效。方法 2006年10月-2008年10月,采用椎间盘置换治疗20例(26个节段)脊髓型颈椎病患者。男8例,女12例;年龄26～65岁,平均46岁。病程2～18个月,平均7个月。单节段置换14例,双节段置换6例。术后以Odom等标准评价疗效,以疼痛视觉模拟评分(VAS)评价颈、肩部及上肢疼痛情况。X线片测量假体椎间盘间隙角及颈椎过屈、过伸位活动度,观察异位骨化、骨赘形成及假体松动等情况。结果术后切口均Ⅰ期愈合,无严重并发症发生。20例均获随访,随访时间30～48个月,平均34个月。术后28个月按Odom等标准获优17例、良3例,颈、肩部及上肢VAS评分均较术前显著改善(P<0.05)。术后30个月,20个置换节段未融合,假体活动度为(10.6±4.5)°,与上位相邻节段的(10.8±3.7)°和下位相邻节段的(7.5±4.2)°比较差异均无统计学意义(P>0.05)。术后10例13个节段发生异位骨化,1例假体后方移位;其他假体无移位、下沉、松动等并发症发生。结论颈椎间盘置换治疗脊髓型颈椎病能维持颈椎正常活动范围和生理弯曲,但其功能和对邻近节段的影响需进一步随访。

Objective To evaluate the effectiveness of cervical disc replacement for cervical myelopathy. Methods Between October 2006 and October 2008, 20 patients （26 segments） with cervical myelopathy underwent single-level （14 segments） or bi-level （6 segments） cervical disc replacement. There were 8 males and 12 females with an average age of 46 years （range, 26-65 years）. The disease duration ranged 2-18 months （mean, 7 months）. The effectiveness was evaluated using visual analogue scale （VAS） score, cervical range of motion （ROM）, and the Odom et al. criteria. Heterotopic ossification （HO）, osteophyte formation, and prosthesis loosening were observed. Results All incisions healed by first intention, with no severe complication. Twenty patients were followed up 30-48 months （mean, 34 months）. At 28 months after operation, according to Odom et al. criteria, the results were excellent in 17 cases and good in 3 cases. The VAS scores of the neck, shoulder, and upper limb were significantly improved when compared with preoperative scores （P 〈 0.05）. At 30 months after operation, X-ray films showed that 20 replaced segments were mobile and ROM was （10.6 ± 4.5）°, showing no significant difference （P 〉 0.05） when compared with that of upper adjacent segment （10.8 ± 3.7）° and lower adjacent segment （7.5 ± 4.2）°. HO occurred in 10 cases （13 segments）. No displacement, subsidence, or loosening occurred except 1 case of retrodisplacement of the prosthesis. Conclusion Cervical disc replacement can obtain good effectiveness. It can maintain normal cervical ROM and physiological curvature. But it needs further long-term follow-up to evaluate the function and the influence on the adjacent segments.