人工颈椎间盘置换术治疗脊髓型颈椎病的疗效观察

Observation on the curative effect of using artificial cervical disc replacement to treat cervical spondylotic myelopathy

目的观察应用人工颈椎间盘置换术治疗脊髓型颈椎病的疗效。方法对20例脊髓型颈椎病患者24个椎间盘行Prestige LP人工颈椎间盘置换术。术后以Odom分级标准评价疗效,以JOA评分评价脊髓功能,以VAS评分评价颈、肩部及上肢疼痛情况。X线片测量假体椎间盘间隙角及颈椎过屈、过神位活动度,观察异位骨化、骨赘形成及假体松动等情况。结果患者均获随访,时间30～48个月。患者神经功能均恢复满意。Odom分级评分:优18例,良2例。脊髓功能JOA评分与术前比较差异有统计学意义(P<0.05),颈、肩部及上肢VAS评分与术前比较差异均有统计学意义(P<0.05)。假体活动度与上、下位相邻节段的活动度比较差异均无统计学意义(P>0.05)。1例单节段于术后24个月发生异位骨化。未见假体移位、松动、下沉等并发症。结论颈椎人工椎间盘置换患者术后恢复快,颈椎稳定性和活动度无明显受损,近期疗效满意。

Objective To observe the curative effect of using artificial cervical disc replacement for treating cervical spondylotic myelopathy. Methods Prestige LP cervical artificial disc replacement surgery was done to treat 24 discs of patients with cervical myelopathy in 20 cases. Postoperative Odom standard was used to evaluate the curative effect and JOA score to judge spinal cord function. VAS score was applied to measure the pain degree of neck, shoulder and upper limb as well as X-ray to measure the prosthetic intervertebral disc space angle, cervical over-flexion and tablets activity, to observe the heterotopic ossification, osteophyte formation and loosening of the prosthesis. Results All patients were followed up for 30 - 48 months. The recovery of 20 patients＇ neurological function was good. Odom function score： excellent in 18 cases, good in 2 cases. JOA score of spinal cord function improved significantly （P 〈 0. 05 ） , VAS score of neck, shoulder and upper extremity improved significantly （ P 〈 0. 05 ）. Both activity of pros- thesis and activity of upper and lower adjacent segments had no statistically significant differences （ P 〉 0. 05 ）. One case after 24 months occurred heterotopic ossification, but no prosthesis displacement, loosening, sinking or other complications were found. Conclusions Prestige LP cervical artificial disc replacement surgery provides satisfactory recent results; patients recover quickly, and without significant damage on cervical stability and activity.