人工椎间盘置换术治疗颈椎病的中远期临床疗效及影像学评价

Medium to long-term evaluation of curative effect and imaging after treatment of cervical spondylosis with cervical artificial disc replacement

[目的]评价颈椎人工椎间盘置换术(cervical artificial disc replacement,CADR)的中远期临床疗效及影像学改变。[方法]回顾性分析20例颈椎病手术至随访时满5年的病例,全部采用单节段Bryan假体CADR治疗。随访时间60～92个月(平均78个月)。[结果](1)术前JOA评分平均(8.8±0.9)分,随访时平均(15.2±1.0)分,平均改善率78%。随访时Odom’s分级临床疗效优良率85%;(2)术前颈椎曲度为(4.7±3.7)mm,随访时为(6.0±3.5)mm;颈椎运动范围及上、下邻近间隙运动范围均无明显变化。随访时可见6个(30%)手术节段出现异位骨化;(3)上邻近节段椎间盘高度无明显变化;下邻近节段椎间盘高度术前为(8.36±0.54)mm,随访时为(7.90±0.87)mm,平均减少(0.46±0.51)mm(P=0.001)。随访时邻近节段退变(adjacent segment degenera-tion,ASD)发生率为15%(6/40个),其中1例(5%,1/20例)患者出现ASD相应的临床症状,保守治疗无明显缓解。[结论]CADR中远期临床疗效良好,颈椎曲度恢复正常,颈椎运动范围及邻近间隙运动范围维持良好,手术节段异位骨化发生率高,ASD发生率较低。

[ Objective] To evaluate the medium to long - term curative effect and imaging change character of cervical ar- tificial disc replacement （CADR） . [ Methods] Twenty cases of the cervical spondylosis＇ s data over 5 years after CADR with single segment Bryan disc prosthesis were analyzed. All these 20 cases were followed up, with period of 60- 92 months （ aver- age, 78 months） . [ Results] （ 1 ） The JOA score was 8.8 ± 0. 9 （pre - operation） and 15.2 ± 1.0 （follow - up）. The im- provement rate was 78%. At final follow - up the excellent curative effect rate with the Odom＇s classification was 85 %. （2） The cervical curvature increased to normal value with （4. 7 ± 3.7） mm at pre - operation, （6. 0 ± 3.5 ） mm at final follow - up, the difference was significant statistically. The cervical range of moving, the range of upper and lower adjacent segment moving all showed no statistical significance at pre - operation and final follow - up. At final follow - up the heterotopic ossification was not- ed in 6 （30%） segments. （3） The disc height of upper adjacent segment didn＇ t have difference statistically. The disc height of lower adjacent segment was （8. 36 ±0. 54） mm at pre - operation, and （7.90 ± 0. 87） mm at final follow - up, the differ- ence value was （0. 46 ± 0. 51 ） mm （ P = 0. 001 ） . The ratio of ASD was 15% （ 6/40 case） at final follow - up, of which in one case （5%, 1/20 case） adjacent segment disease was noted, without cure effect after conservative treatment. [ Conclu- sion ] After following 6. 5 years, the clinic cure is good, the cervical curvature increase to normal value, the cervical range of moving and the range of adjacent segment moving both keep good, the ratio of heterotopic ossification is high, and the ratio of ASD is lower.