Activ-C颈椎人工椎间盘置换和颈椎融合术后的颈椎运动学及放射学改变

Cervical kinematics and radiological changes after Activ-C artificial disc replacement versus fusion

目的 对比Activ-C颈椎人工椎间盘置换和颈椎融合术后的颈椎运动学及放射学改变,观察两种术式对颈椎功能的影响.方法 手术治疗的单节段颈椎病患者92例,按照手术方法不同分为Activ-C颈椎人工椎间盘置换（ADR）和颈椎椎间融合（ACDF）两组,其中ADR组43例,ACDF组49例.对两组患者术前及术后颈椎功能障碍指数（NDI）、疼痛视觉模拟评分（VAS）、日本矫形外科协会评分（JOA）、颈椎曲度指数（CCI）、颈椎总活动度（ROM）、邻近节段活动度（MAL）进行分析.结果 所有患者均获随访,随访时间12 ～ 36个月,平均18.2个月.ADR组和ACDF组JOA评分分别由术前（8.1±0.7）分和（8.2±0.6）分升高至末次随访时的（14.9±0.8）分（P＜0.05）和（14.5 ±0.70）分（P＜0.05）,VAS评分分别由术前（7.2±0.5）分和（7.4±0.3）分降低至末次随访时的（1.2±0.6）分（P＜0.05）和（2.1±0.4）分（P＜0.05）,NDI评分分别由术前（51.5±28.4）分和（52.1±27.3）分降低至末次随访时的（31.4±20.3）分（P＜0.05）和（33.6±18.2）分（P＜0.05）,两组之间比较差异无统计学意义（P＞0.05）;CCI分别由术前（14.60±2.94）％和（14.66±3.05）％降低至末次随访时的（14.03±2.76）％ （P ＞0.05）和（12.08±2.65）％ （P ＜0.05）;ACDF组ROM术后较术前有明显减少[术后末次随访（35.4±12.7）°,术前（48.2±13.8）°,P＜0.05],而ADR组与术前比较差异无统计学意义[术后末次随访（45.2±13.5）°,术前（47.7±13.4）°,P＞0.05];ACDF组术后邻近节段活动度变大[术后末次随访上一节段MAL（10.9±1.4）°、下一节段MAL（12.4±2.2）°,术前上一节段MAL（8.9±1.9）°、下一节段MAL（9.0±2.3）°,P＜0.05],显著高于ADR组[术后末次随访ADR组上一节段MAL（9.7±1.6）°、下一节段MAL（9.2±2.1）°,P＜0.05].结论 Activ-C颈人工椎间盘置换术和颈椎前路减压融合术临床疗效相近,同时保留了手术节段运动功能,手术相邻节段的活动度并无增加,并能有效维持颈椎曲度.

Objective To compare the cervical kinematics and radiographic changes after Activ-C artificial disc replacement （ADR） with anterior cervical decompression and fusion （ACDF） and analyse the effect of cervical function after the surgury.Methods A retrospective analysis of ninety-two cases with symptomatic single level cervical degenerative diseases received the surgeries.Owing to different surgeries,these patients were divided into two groups：ADR and ACDF.43 patients underwent ADR and 49 patients underwent ACDF.Nneck disability index （NDI）,visual analog scale （VAS）,Japanese Orthopaedic Association （JOA）,cervical curvature index （CCI）,range of motion （ROM） and activity of adjacent segments （MAL） during follow-up were observed.Results All the patients were received the follow-up.The average follow-up periods were 18.2 months （range,12-36 months）.The postoperative scores of the JOA （ADR group 14.9 ± 0.8 and ACDF group 14.5 ± 0.7） were significantly improved compared with preoperative scores （ADR group 8.1 ± 0.7 and ACDF group 8.2 ± 0.6） （P ＜ 0.05）,while VAS （ADR group 1.2 ±0.6 and ACDF group 2.1 ±0.4） and NDI （ADR group 31.4 ±20.3 and ACDF group 33.6 ± 18.2） were decreased compared with preoperative ones （VAS：ADR group 7.2 ± 0.5 and ACDF group 7.4 ± 0.3,P ＜ 0.05） （NDI：ADR group 51.5 ± 28.4 and ACDF group 52.1 ± 27.3,P ＜ 0.05）.No significant difference was found between the two groups （P ＞ 0.05）.Cervical curvature after ACDF （12.08 ± 2.65） ％ were lost significantly compared to preoperative CCI （14.66 ± 3.05） ％ （P ＜ 0.05）.However,this phenomenon was not present in ADR （preoperative CCI：1 （4.60 ± 2.94） ％,postoperative CCI：（14.03 ± 2.76） ％ （P ＞ 0.05）.In ACDF group,ROM was significantly decreased postoperatively （preoperative ROM：（48.2 ± 13.8） °,postoperative ROM：（35.4 ± 12.7） ° （P ＜ 0.05）,but in ADR group,there were no significant differences between postoperative （45.2 ± 13.5）° and preoperative （47.7 ±13.4）° ROM （P＞0.05）.The MAL （preoperative MAL：lower （9.0 ±2.3）°,upper （8.9 ± 1.9）°;postoperative MAL：lower （12.4 ± 2.2） °,upper （10.9 ± 1.4） ° of the ACDF group increased obviously after operation,and it was significantly higher than the ADR group （postoperative MAL：lower （9.2 ±2.1） °,upper （9.7 ± 1.6） ° （P ＜ 0.05）.Conclusion Activ-C artificial disc replacement has similar clinical efficacy comparing with ACDF.It can retain normal motion of surgical segment and cervical lordosis.But the MAL was not increased.