颈前路减压植骨融合与Bryan人工颈椎间盘置换疗效比较

Clinical Effect of Anterior Disc Excision with Bone Graft Fusion and Bryan Artificial Cervical Disc Replacement

目的探讨颈椎前路减压植骨融合术(anterior cervical decompression and fusion,ACDF)与Bryan人工颈椎椎间盘置换术(artificial cervical disc replacement,ACDR)两种手术方式用于治疗脊髓型颈椎病及神经根型颈椎病的近期和远期疗效。方法系统分析我院2010年11月至2012年11月70例(70个节段)脊髓型或神经根型颈椎病患者病例资料,将70例(70个节段)脊髓型或神经根型颈椎病患者,通过随机数字表法随机分为ACDF组(35例)及Bryan组(35例)。通过分析术前及术后随访12个月的Odom's标准评分、活动度(range of motion,ROM)、日本骨科协会(Japanese orthopaedic association,JOA)、健康调查简表(the MOS item short from health survey,SF-36)及颈椎残障功能指数(neck disability index,NDI)观察指标的差异,同时对随访12个月的上述各项指标进行两组间比较,比较两者疗效,分析两种术式的优点及他们产生的问题。结果两种手术方式都能取得明确疗效,治疗后患者症状明显缓解(P<0.05),两种术式在创伤、出血量等方面差异性不显著(P>0.05);JOA评分及SF-36评分两者差异性不显著(P>0.05);而在12个月随访ROM评估及NDI比较有差异,Bryan组数据优于ACDF组,差异具有统计学意义(P<0.05);Bryan组在Odom's评分中因减压不彻底及异位骨化,有2例等级为差,ACDF组则为0例。结论 Bryan人工颈椎椎间盘置换术在减少颈椎临近节段退变上优于ACDF,短中期疗效优于ACDF,但Bryan人工颈椎椎间盘置换术同时存在减压不彻底及异位骨化等并发症,远期疗效不如ACDF。

Objective To study the immediate and long-term efficacy of anterior cervical decompression and fusion（ AC-DF）and artificial cervical disc replacement（ ACDR）in the treatment of cervical myelopathic spondylosis and cervical spondy-losis of nerve root type. Methods We systematically analyzed data of 70 cases（70 segments）of patients with cervical spondy-lotic myelopathy and nerve-root type cervical spondylosis who were hospitalized from November 2008 to November 2010. They were randomly divided into ACDF group（35 cases）and Bryan group（35 cases）by random number table method. We observed the differences of index by the analysis of odom′s,ROM,JOA,SF-36 and NDI at before and the follow-up of 12 months after operation. We simultaneously compared the indicators at the follow-up of 12 months between the two groups,compared the cur-ative effect,and analyzed the advantages of the two kinds of operation methods and the problems they caused. Results The two operation method could achieve definite curative effect ,the symptoms were significantly alleviated after treatment（ P 〈0. 05）. Both operation methods had no significant differences in trauma,bleeding volume and so on（P〉0. 05）. JOA score and SF-36 scale had no significant differences（P〉0. 05）. There was difference between ROM and NDI in the evaluation of 12 month follow-up. Data of Bryan group were better than ACDF group（P〈0. 05）. Conclusion Bryan artificial cervical disc re-placement（ACDR）is superior to the anterior cervical decompression and fusion（ACDF）in reducing the adjacent segment degeneration of cervical vertebra. Its short-term and mid-term curative effect is superior to the ACDF. But Bryan artificial cervi-cal disc replacement（ ACDR）coexist the complications such as incomplete decompression and heterotopic ossification,the long-term curative effect is inferior than ACDF.