改良Bryan人工间盘置换术对置换节段曲度和轴性症状的影响

Effect of modified techniques of Bryan cervical disc arthroplasty on the curvature of the operated segments and axial symptom

[目的]评估改良Bryan人工间盘置换术治疗颈椎病的临床疗效及其对术后置换节段曲度和颈部轴性症状的影响。[方法]改良Bryan人工间盘置换术的方法包括:平行于病变椎间隙置入人工间盘假体,减少对终板的过度研磨,保证假体两片钛合金终板的前缘在同一条直线上。2006年8月～2009年2月,对30例颈椎病患者行改良Bryan人工颈椎间盘置换术(改良组)。2005年1～2006年7月,按照Bryan人工间盘产品专论(medtronic sofamor danek,minneapolis,MN,USA)描述的方法行人工间盘置换的患者共21例,作为对照(标准组)。对两组患者手术前、后的颈椎功能障碍指数(neck disability index,NDI)评分、生活质量量表(Short Form-36,SF-36)评分、颈项疼痛视觉模拟(visual analog scale,VAS)评分和手术节段脊柱功能单位(functional spinal unit,FUN)角度等结果进行对照评价。[结果]末次随访时(术后24个月),改良组和标准组患者术后NDI评分和SF-36评分较术前均有明显改善,但两组之间差异无统计学意义。两组患者术前轴性颈痛VAS评分差异无统计学意义;术后差异有统计学意义,改良组轴性症状严重程度明显轻于标准组。改良组患者手术节段FUN角平均增加(3.5±2.5)°,而标准组FUN角平均减小(1.8±5.0)°,两组术后FUN角改变差异有统计学意义。[结论]改良Bryan人工间盘置换术后,能够有效改善术后手术节段曲度,降低轴性症状的严重程度。

[ Objective] This study was designed to investigate the modified techniques of cervical arthroplasty with Bryan disc and analyze their effects on the curvature of the operated segments and axial symptom. [ Methods ] Modified techniques in- eluded change in disc insertion, reducing overmilling of endplates, the assurance of the anterior borders at the same horizontal line. From August 2006 to February 2009, modified techniques were applied to 30 patients （ modified group） . From January 2005 to July 2006, techniques described in the Bryan disc product monograph （ Medtronic Sofamor Danek, Minneapolis, MN, USA） were applied to 21 patients （standard group） . Clinical and radiologieal outcomes of all patients were performed before surgery and at final follow- up （24 months after surgery） . Comparisons between the two groups in terms of the Neck Disability Index score, Short Form -36 score, neck pain Visual Analog Scale （VAS） score and functional spinal unit （FSU） angle of the operated segments were performed. [ Results] Both of the two groups had significantly improvement than preoperative in NDI and SF - 36 scores. At final follow - up, the severity of axial symptom was significantly less in modified group than in standard group. The mean FSN angle increased by （3.5 ±2. 5） ° in modified group, whereas this angle decreased by （ 1.8 ±5. O）°in standard group at the final visit. There was no statistically significant difference between the groups regarding preoperative and postoperative scores with the exception of neck pain VAS and FSU angle changes. [ Conclusion ] Our modified techniques are associated with good outcomes such as maintaining the cervical curvature of operated segments and lowering the severity of postoperative axial symptoms.