PCM人工颈椎间盘置换术后7年疗效观察

Observation of 7-year curative effects of PCM replacement

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.