Bryan人工间盘置换与前路减压融合治疗颈椎退行性疾病的中期随访研究

Comparison of the mid-term follow-up results between Bryan cervical artificial disc replacement and anterior cervical decompression and fusion for cervical degenerative disc disease

目的评价人工椎间盘置换术治疗颈椎退行性疾病的中期疗效，并探讨其是否可以减少邻近节段退变的发生。方法前瞻性对比分析接受颈椎人工间盘置换术（置换组，45例）与颈椎前路减压融合术（融合组，48例）治疗的颈椎退行性疾病患者的随访6年临床疗效和影像学资料。临床疗效评价指标为日本骨科协会评分（JapaneseOrthopaedicAssociationScores，JOA）、颈椎功能残障指数量表（neckdisabilityindex，NDI）和Odom评分。影像学评价指标为矢状位曲度、活动度、邻近节段退变。结果28例置换组患者和35例融合组患者完成随访。两组患者末次随访的JOA评分和NDI均较术前有明显改善，组间比较差异无统计学意义。92．9％的置换组患者和97．1％的融合组患者Odom评分获得很好或较好的结果。两组患者颈椎矢状位曲度末次随访较术前均得到保持。颈椎整体活动度置换组末次随访与术前无明显差异，而融合组则是明显降低。置换组置换节段活动度术前为9．5°±3．7°，术后3个月为7．0°±3．0°，末次随访为6．6°±4．1°，末次随访较术后3个月无明显改变。邻近节段退变评估采用侧位x线片和MRIT2加权像，置换组上、下邻近节段退变均明显少于融合组。结论Bryan人工椎间盘置换术6年的随访结果基本满意，能更好地保留颈椎生理活动及生物力学环境，从而降低邻近节段退变的发生率。

Objective To evaluate the mid-term follow-up results of cervical artificial disc replace- ment （CADR） for cervical degenerative disc disease, and to explore whether it can reduce the occurrence of adjacent segment degeneration （ASD）. Methods A prospective comparative study of 93 patients who un- derwent CADR or anterior cervical decompression and fusion （ACDF） for cervical degenerative disc disease were conducted. All patients were followed up for more than 6 years. The Japanese Orthopaedic Association （JOA） score, neck disability index （NDI）, Odom＇s scale, X-rays and magnetic resonance imaging （MRI） were used to evaluate the clinical and radiologic results. Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data. At final follow-up, the JOA score and NDI improved significantly in both groups. Between the two groups, there was no significant difference in terms of JOA score, NDI and Odom＇s scale. The sagittal alignment was well maintained in both groups. The total cervical spine range of motion （ROM） had no significant change for the CADR group, whereas, it signif- icantly decreased for the ACDF group. The ROM at the replacement level of CADR patients decreased from 9.5°± 3.7° before operation to 7.0° ± 3.0°3 months after operation, and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease. Lateral radiographs and Tz-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group. Conclusion The six-year follow- up results of CADR are basically satisfactory. Compared with ACDF, it could better preserve physiological motion and biomechanics of cervical spine, and reduce the incidence of ASD.