摘要
目的观察 PCM 人工颈椎间盘( artifical cervical porous coated motion disc )置换术7年随访结果,评价中远期疗效。方法我院自2004年12月开展 PCM 颈椎人工椎间盘置换术以来,术后超过7年的患者共23例,其中19例获得84~98个月(平均91个月)随访。男11例,女8例。单节段置换12例,双节段置换5例,3节段置换2例。C3/42例、C4/56例、C5/616例、C6/75例。术前和末次随访时进行 JOA、VAS、NDI 评分,末次随访时进行 Odom’s 分级评估临床疗效;术前和末次随访时,在过伸过屈侧位 X 线片上测量置换节段活动度,在侧位 X 线片上采用 McAfee 异位骨化分级方法评定异位骨化和相邻节段退变程度。结果术中或术后无神经和血管损伤并发症。JOA 评分术前为(12.3±2.2)分,末次随访时(15.9±1.2)分;平均改善率76.5%。颈肩痛 VAS 评分术前为(3.6±1.5)分,末次随访时(1.8±1.1)分;上肢痛 VAS 评分术前为(6.4±2.5)分,末次随访时(1.7±1.2)分;NDI 术前评分为(25.7±12.5)分,末次随访时(7.7±3.5)分。末次随访时 Odom’s 分级优7例,良10例,可2例,差0例。术前置换节段活动度为(5.7±2.8)°,末次随访时为(3.8±2.5)°。末次随访时,28个手术节段中7个(25%)出现异位骨化,其中1个(7%)节段丧失活动度。19例相邻节段无明显退变5例,轻度退变12例,重度退变2例。无翻修病例。结论PCM 颈椎人工椎间盘置换术后7年以上的中期随访临床和影像学结果满意,手术节段活动度得到一定保留。
Objective To observe the 7-year follow-up results of artificial cervical porous coated motion ( PCM ) disc replacement, and to evaluate the mid-long-term effects. Methods Since PCM cervical disc replacementwas started in our hospital in December 2004, more than 7 years had passed after the operation in 23 patients. 19 patients were followed up for a mean period of 91 months ( range; 84-98 months ), among whom there were 11 males and 8 females. There were 12 cases of single-level replacement, 5 two-level and 2 three-level. The surgical levels included C3/4 in 2 cases, C4/5 in 6 cases, C5/6 in 16 casesand C6/7 in 5 cases. The clinical evaluation included japanese orthopedic association ( JOA ) and visual analogue scale ( VAS ) scores preoperatively and in the latest follow-up, and Odom's grading criteria was used in the latest follow-up. Preoperatively and in the latest follow- up, the range of motion ( ROM ) of the replacement segments was measured on the hyperextension, hyperflexion and lateral X-rays, and heterotopic ossification and adjacent level degeneration were evaluated according to the McAfee classification on the lateral X-rays. Results No complications such as injuries of nerves or blood vessels were found during and after the operation. The JOA scores were ( 12.3±2.2 ) points and ( 15.9±1.2 ) points preoperatively and in the latest follow-up, while the average improvement rate was 76.3%. The VAS scores for neck and shoulder pain were ( 3.6±1.5 ) points and ( 1.8±1.1 ) points preoperatively and in the latest follow-up. The VAS scores for upper limb pain were ( 6.4±2.5 ) points and ( 1.7±1.2 ) points preoperatively and in the latest follow-up. The neck disability index ( NDI ) scores were ( 25.7±12.5 ) points and ( 7.7±3.5 ) points preoperatively and in the latest follow-up. According to the Odom's grading criteria, there were 7 excellent cases, 10 good, 2 fair and 0 poor in the latest follow-up. The ROM of replacement segments was ( 5.7±2.8 )°preoperatively and ( 3.8±2.5 )° in the latest follow-up. Heterotopic ossification was noted in 7 of 28 segments ( 25% ), and loss of movement was found in 1 segment ( 7% ) in the latest follow-up. 5 of the 19 patients had no obvious degeneration at adjacent levels, 12 slight degeneration and 2 severe degeneration. No patients needed revision surgery. Conclusions PCM cervical disc replacement provides satisfactory clinical and radiological outcomes in the more than 7-year mid-term follow-up, and the ROM of operational segments is partially preserved.
出处
《中国骨与关节杂志》
CAS
2013年第6期313-317,共5页
Chinese Journal of Bone and Joint
关键词
椎间盘退行性变
椎间盘移位
全椎间盘置换
颈椎病
颈椎
Intervertebral disc degeneration
Intervertebral disc displacement
Total disc replacement
Cervical spondylosis
Cervical vertebrae