单节段颈椎人工椎间盘置换与前路椎间融合内固定:维持颈椎活动度和稳定性的比较

Single level artificial disc replacement versus anterior cervical fusion: range of motion and stability of cervical vertebra

背景:单节段颈椎病的融合治疗可导致邻近节段运动范围异常加大及退行性表现等并发症。近年来许学者开始探索用非融合技术来替代传统融合治疗。颈椎人工椎间盘置换作为一种新型的前路非融合方案越来越多地应用于临床,不仅取得了较好的临床效果,还能使颈椎椎体接近生理性稳定、延缓相邻节段退变以及减少并发症发生。目的:比较单节段颈人工椎间盘置换与颈前路减压融合内固定修复颈椎病的临床疗效。方法:2011年5月至2013年5月郑州大学第一附属医院收治了59例影像学显示颈椎单节段椎间盘退变压迫脊髓或神经根并与临床症状和体征相符合的单节段颈椎病患者,因治疗方式不同随机分为颈椎人工椎间盘置换组(置换组)和颈椎前路减压融合组(融合组),其中置换组32例,融合组27例。治疗后5 d及治疗后3,6,12个月进行随访,测量脊髓功能JOA评分以及颈痛、上肢疼痛目测类比评分,观察置换节段的活动度及对相邻节段的影响。结果与结论:两组治疗后各时间段的JOA评分较治疗前增加(P<0.05),目测类比评分较治疗前减少(P<0.05),但两组间比较差异无显著性意义(P>0.05)。置换组治疗后置换节段活动度为(11.6±3.0)°,与治疗前(8.8±2.7)°。差异无显著性意义(P>0.05)。融合组治疗后3个月融合基本上无明显活动。随访时置换组相邻节段活动度小于融合组(P<0.05);置换组治疗前后相邻节段活动度差异无显著性意义(P>0.05);而融合组治疗前后差异有显著性意义(P<0.05),治疗后活动度明显增大。提示与前路减压融合比较,颈椎人工椎间盘置换不仅能改善临床症状,恢复神经功能,还能保持颈椎置换节段的活动度和稳定性,且对手术临近节段活动度无明显影响,可有效的维持颈椎曲度。

BACKGROUND：Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications. OBJECTIVE：To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis. METHODS：A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrol ed from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group （replacement group;n=32） and anterior cervical decompression and fusion group （fusion group;n=27）. They were fol owed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed. RESULTS AND CONCLUSION：The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores （P〈0.05）, while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores （P〈0.05）. There were no significant differences between two groups （P〉0.05）. Range of motion of the replacement segment after treatment was （11.6±3.0）° in the replacement group, showing no significant differences as compared with before surgery （8.8±2.7）° （P〉0.05）. No significant activity was found at 3 months after treatment in the fusion group. During fol ow-up, the range of motion in the adjacent segments was smal er in the replacement group than in the fusion group （P〈0.05）. No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group （P〉0.05）, but significant differences in the range of motion were detected before and after treatment in the fusion group （P〈0.05）. The range of motion was apparently increased after treatment. These findings indicated that compared with the anterior cervical decompression and fusion, cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the range of motion and stability of the cervical replacement segment. Moreover, it does not have impacts on the range of motion in the segments near to the surgical wound, and can effectively maintain cervical curvature.