Activ C人工椎间盘置换术治疗颈椎病的早期疗效

Preliminary results of Activ C artificial disc replacement for cervical spondylosis

目的：观察Activ C人工椎间盘置换术治疗颈椎病的早期临床疗效，分析其临床应用价值。方法：2009年11月～2011年3月在我院接受Activ C人工椎间盘置换术并获得随访的颈椎病患者共43例（45个节段），平均年龄48.3岁，其中男18例，女25例，脊髓型颈椎病22例，神经根型颈椎病16例，混合型颈椎病5例；单节段置换41例（C3/4 2例，C4/5 17例，C5/6 21例，C6/7 1例），双节段置换2例（C4/5和C5/6 1例，C5/6和C6/7 1例）。采用日本骨科协会JOA评分、颈椎活动障碍指数（NDI）和疼痛视觉模拟评分（VAS）评价术后症状改善程度，比较手术前后的颈椎曲度、手术节段及邻近上下节段活动度变化，观察统计手术并发症情况。结果：术后随访8~24个月，平均13.8个月。患者的JOA评分、NDI、颈部VAS评分、上肢VAS评分分别由术前的8.2±0.7、35.3±4.7、6.8±1.1和6.5±1.2分显著改善至末次随访时的14.7±0.4、16.2±3.4、1.3±0.8和1.8±0.9分（P均＜0.05）。颈椎生理曲度术前为7.97°±4.49°，末次随访时为9.15°±3.85°，手术前后无明显差异（P＞0.05）。置换节段活动度较术前明显增加（P＜0.01），邻近上下节段活动度手术前后差异无统计学意义（P＞0.05）。术后人工椎间盘活动良好，无塌陷或移位，随访期间未见邻近节段明显退变，2例分别在术后7个月和10个月时异位骨化形成。结论：Activ C人工椎间盘置换术可有效改善颈椎病患者的临床症状，维持颈椎的生理曲度和活动度，早期临床疗效满意。

Objectives： To investigate the early clinical effects of cervical Activ C artificial disc replacement. Methods： 43 patients（mean age 48.3 years; 18 males and 25 females） of cervical spondylosis with a total of 45 levels involved underwent anterior cervical decompression and Activ C implantation between November 2009 and March 2011. There were 22 cases of cervical spondylotic myelopathy, 16 cases of cervical spondylotic radiculopathy and 5 cases of mixed cervical spondylosis. Clinical index（Japanese Orthopedic Association scale, neck disability index and visual analogues scale） and radiological parameters（Cobb angle of cervical curvature and segmental ROM） during follow-up were observed. Results： The follow-up averaged 13.8 months（range, 8-24 months）. The mean JOA improved from 8.2±0.7 to 14.7±0.4（P〈0.05）, and the mean NDI improved from 35.3±4.7 to 16.2±3.4（P〈0.05）. The mean VAS on neck pain and arm pain was 6.8±1.1 and 6.5±1.2 respectively before operation and significantly decreased to 1.3±0.8 and 1.8±0.9 respectively at final follow-up. The Cobb angle of cervical curvature was 7.97°±4.49° and 9.15°±3.85° for baseline and final follow-up with no significant difference（P〉0.05）. The ROM of the operated segments increased obviously（P〈0.05） after operation, and the ROM of the adjacent segments did not change during follow-up. Two cases were complicated with heterotopic ossification in 7 and 10 months respectively. Conclusions： The Activ C artificial disc replacement can achieve good clinical outcomes for cervical spondylosis. Longer follow-up and morphological evaluation of the results are necessary to evaluate long-term segmental mobility and clinical outcomes.