人工颈椎椎间盘置换联合融合治疗多节段颈椎病的早期疗效观察

Early clinical efficacy of artificial cervical disc replacement combined with anterior cervical discectomy and fusion in treatment of patients with multi-level cervical spondylosis

目的通过术后随访评价人工颈椎椎间盘置换(artificial cervical disc replacement,ACDR)联合前路减压植骨融合(anterior cervical discectomy and fusion,ACDF)治疗多节段颈椎病的早期疗效,分析置换节段与融合节段之间的相互影响。方法回顾性分析15例ACDR联合ACDF病例(杂交手术组)和15例多节段ACDF病例(融合手术组)的临床资料。采用疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能残障指数(neck disability index,NDI)、椎间隙高度、颈椎总活动度和节段活动度占颈椎总活动度的百分比值等指标进行综合评价。结果杂交手术组15例患者平均随访21.1个月,融合手术组15例患者平均随访25.1个月。2组病例术后各随访点VAS评分、NDI均较术前显著下降(P<0.01)。末次随访时杂交手术组置换节段活动度占颈椎总活动度的百分比值与术前相比明显增大(P<0.05),上下位邻近节段与术前相比无统计学差异(P>0.05)。末次随访时融合手术组上下位邻近节段活动度均较术前显著增大(P<0.01)。术后随访时间内未观察到装置松动、移位等相关并发症。结论 ACDR联合ACDF治疗多节段颈椎病具有良好早期临床疗效,在维持颈椎运动功能的同时减少邻近节段运动负荷,是多节段颈椎病手术治疗的一种新选择。

Objective To evaluate the early clinical efficacy of artificial cervical disc replacement （ACDR） combined with anterior cervical discectomy and fusion （ACDF） in treatment of patients with multi-level cervical spondylosis, and to analyze the interaction effect between the replacement segment and fusion segment. Methods Fifteen patients with ACDR combined with ACDF （hybrid surgery, HS） and 15 patients with multi-level ACDF （M-ACDF） were enrolled in this retrospective study. Visual analogue scale （VAS） scores for neck and arm pain, neck disability index （NDI）, disc space height, total cervical range of motion （ROM）, and segmental ROM contribution to total cervical ROM were measured. Results The average duration of follow-up was 21.1 months in the HS group and 25.1 months in the M-ACDF group. VAS and NDI scores in both groups were significantly lower at all follow-up time points as compared with their preoperative scores （P〈0.01）. Compared with preoperative scores, the replacement segmental ROM contribution to total cervical ROM in the HS group significantly increased at final follow-up （P〈0.05）, but no significant difference was observed in upper and lower adjacent segment （P〉0.05）. However, the contribution of upper and lower adjacent segment in the ACDF group significantly increased as compared with the preoperative levels （P〈0.01）. There was no complication related to the devices, such as loose, migration, and so on. Conclusion ACDR combined with ACDF in treatment of patients with multi-level cervical spondylosis can achieve satisfied early clinical efficacy. It not only maintains the cervical motion function, but also reduces the adjacent segment motion load after hybrid surgery. It is an alternative choice for multi-level cervical spondylosis treatment.