颈椎人工椎间盘置换术联合显微减压治疗颈椎病的临床疗效

Outcome of microsurgicai decompression combined with cervical artificial disc replacement

目的研究颈椎人工椎间盘置换联合显微减压治疗颈椎病的临床疗效。方法2006年1月至2011年11月，对21例颈椎病患者共23个椎间隙行前路显微镜下椎间盘减压联合颈椎人工椎间盘置换术，患者中男性11例，女性10例；年龄28～60岁，平均46．3岁。诊断为神经根型颈椎病5例，脊髓型颈椎病16例。应用Bryan假体治疗9例患者共10个椎间隙，ProDisc—C假体治疗12例患者共13个椎间隙。随访时进行日本骨科协会（JOA）评分、颈椎障碍功能指数（NDI）和视觉模拟量表（VAS）评分，并采用配对t检验对不同时间点的评分进行分析。结果患者术后随访6～74个月，平均27．7个月。1例椎管骨性狭窄患者。术后症状改善遗留疼痛，经过再次后路减压术后缓解，预后较好。其余患者随访期间症状均缓解明显，置换节段稳定，没有假体下沉和明显偏移。术后1个月、末次随访时与术前比较，JOA评分（t=9．195和17．070）、NDI评分（t=7．193和14．062）和VAS评分（扭14．851和16．133）差异均有统计学意义（P〈0．05）；术后1个月和末次随访时比较，JOA评分（t=5．916）、NDI评分（t=7．722）和VAS评分（t=4．564）差异均有统计学意义（P〈0．05）。结论颈椎人工椎间盘置换联合显微减压手术能彻底去除对神经组织产生压迫的致压物，疗效更有保障。

Objective To study the microsurgical decompression combined with cervical artificial disc replacement clinical efficacy for the treatment of cervical spondylosis. Methods From January 2006 to November 2011, 21 cases of cervical spondylosis, totally 23 intervertebral spaces, were under the microscope disc decompression and cervical artificial disc replacement. There were i 1 male and 10 female patients; aged from 28 to 60 years, with an average of 46. 3 years. The diagnosis included 5 cases of nerve root type cervical spondylosis and 16 cases of cervical spondylotic myelopathy. Application of Bryan prosthesis treatment of 9 patients, a total of 10 intervertebral spaces; ProDisc-C prosthesis to treat 12 patients, a total of 13 intervertebral space. Following-up Japanese Orthopedic Association （ JOA）, neck disability index （NDI） and visual analogue scale （VAS） scores were recorded and compared with pre- operative scores by the paired t-test. Results The patients were followed up for 6 to 74 months, with an average of 27.7 months. Although a patient with spinal bony stenosis symptom improved, but not satisfied, and after the posterior decompression, who had a better prognosis. The remaining patients during follow-up symptoms were obvious improved, and the replacement segments were stable. There was no prosthesis subsidence and significantly offset. In 1 month post-operation and last follow-up compared with pre-operative scores, JOA （t=9.195 and 17.070）, NDI（t =7. 193 and 14.062） and VAS（t =14.851 and 16. 133） scores were significantly different （ P 〈 0. 05 ） ; and 1 month post-operation compared with last follow-up, JOA （ t = 5. 916）, NDI （ t = 7. 722） and AS （ t = 4. 564） scores were significantly different （ P 〈 0. 05 ）. Conclusions Cervical artificial disc replacement combined with microscopic decompression surgery can completely remove the oppression of nerve tissue caused by pressure, and the efficacy is more secure.