单节段Prestige LP人工颈椎间盘置换术后置换节段活动度的影响因素分析

Analysis of the factors that influence the segmental range of motion after single level Prestige LP disc replacement

目的观察单节段Prestige LP人工颈椎间盘置换术后置换节段活动度的变化情况,分析影响术后活动度的因素。方法对2008-02-2013-04在我院行单节段Prestige LP人工颈椎间盘置换术的51例患者资料进行回顾性分析,所有患者手术前后均行颈椎正侧位和功能位X线检查,分析拟置换节段椎间隙高度和活动度、拟置换节段脊柱功能单位(FSU)与上位椎体高度比值和FSU角度与术后置换节段活动度的关系。结果 (1)术前拟置换节段与邻近节段椎间隙高度比值<0.8的患者术后置换节段活动度平均为7.1°,≥0.8的患者平均为11.4°,有显著性差异(P<0.05);(2)术前拟置换节段活动度<6°的患者术后置换节段活动度平均为7.1°,≥6°的患者平均为11.2°,有显著性差异(P<0.05);(3)术后置换节段FSU高度与上位椎体高度比值下降≥0.08的患者术后活动度平均增加0.26°,<0.08的患者平均增加1.69°,有显著性差异(P<0.05);(4)术前FSU后凸组术后置换节段活动度平均为9.3°,无后凸组术后活动度平均为11.8°,无显著性差异(P>0.05)。结论术前病变节段椎间隙高度丢失>20%和(或)屈伸活动度之和<6°的患者行Prestige LP人工颈椎间盘置换术后置换节段活动度较差,且术后FSU高度下降影响置换节段活动度。

Abstract：Objective To investigate the factors that influence the range of motion（ROM） of the operative level after single level Prestige LP disc replacement. Methods 51 cases with single level Prestige LP disc replacement in one center from February 2008 to April 2013 were reviewed. All patients were examined on lateral and flexion-extension radiographs,ROM of operative level, height ratio of operative disc and adjacent discs,height ratio of FSU （functional spinal unit） and upper vertebral body,and FSU angle were measured and analyzed. Results The postoperative segmental ROM of the height ratio of operative disc and adjacent discs 〈0.8 group averaged 7.1°,and post- operative segmental ROM of height ratio ≥0.8 group averaged 11.4° with statistical significance （P〈0.05）. The postoperative segmental ROM of preoperative ROM 〈6° group averaged 7.1° ,and preoperative ROM≥6° group averaged 11.2° with statistical significance （P〈0.05）. The postoperative segmental ROM of FSU decreased group （preoperative height ratio of FSU and upper vertebral body-postoperative ratio≥0.08） increased 0.26°,and FSU without change group （preoperative height ratio of FSU and upper vertebral body-postoperative ratio〈0.08）increased 1.69° with statistical signif-icance （P〈0.05）. The postoperative segmental ROM of FSU kyphosis group averaged 9.3°,and FSU lordosis group averaged 11.8° without statistical significance（P〉0.05）. Conclusion Cases with a loss of preoperative disc height more than 20% and （or） cases with preoperative ROM of operative lev- el〈6° have poor ROM after Prestige LP cervical disc replacement, moreover, decreased FSU height after Prestige LP disc replacements lead to decreased ROM of operative level.