人工颈椎间盘置换术治疗颈椎病的研究进展

Advances in cervical artificial disc replacement for cervical spondylosis

颈前路减压融合术(anterior cervical decompression and fusion,ACDF)治疗神经根型颈椎病和脊髓型颈椎病已有半个世纪,并取得良好的临床疗效,随着随访时间的不断延长,术后与融合节段相关并发症逐渐凸显出来。因此,在保留颈椎稳定性及活动度双重要求下,非融合理念孕育而生。人工颈椎间盘置换术(cervical artificial disc replacement,CADR)作为颈椎非融合技术迅速发展起来,随着人工假体材料和设计理念的不断发展以及手术操作的规范与熟练,CADR取得了优于ACDF的短中期临床疗效。与ACDF相比,CADR主要优势在于术后恢复快,维持植入节段颈椎活动度及稳定性,恢复颈椎间隙高度,降低邻近节段应力及手术翻修率。在临床工作中,CADR作为一项新兴技术,要求脊柱外科医师严格掌握手术适应证、禁忌证及患者整体情况。该文对CADR研究进展进行了综述,以期为临床治疗颈椎病提供新思路。

Anterior cervical decompression and fusion (ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement (CADR) developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short-and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients' conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.