人工颈椎间盘与颈椎动态稳定器治疗颈椎病的早中期临床疗效和影像学分析

A comparison of cervical disc arthroplasty versus dynamic cervial implant in the treatment of cervical spondylopathy: a clinical and radiological study

目的比较Prodisc-C人工颈椎间盘和颈椎动态稳定器（dynamic cervical implant,DCI）治疗颈椎病的早中期临床疗效和影像学改变。方法回顾性分析2011年2月至2013年2月,因颈椎病于我院骨科行颈前路Prodisc-C人工颈椎间盘置换术和DCI固定术患者的临床和影像学资料,颈前路Prodisc-C人工颈椎间盘置换术（Prodisc-C组）患者16例,男8例,女8例,平均年龄44.0（32~54）岁,诊断脊髓型颈椎病10例,神经根型颈椎病6例;行DCI固定术（DCI组）患者10例,男6例,女4例,平均年龄44.5（33~55）岁,脊髓型颈椎病7例,神经根型颈椎病3例。对两组患者性别、年龄、手术时间、出血量等基本情况进行分析,分别于术后1、3、6、12、24个月进行随访,采用颈肩功能障碍指数（neck disability index,NDI）、日本骨科协会（Japanese orthopaedic association,JOA）评分和疼痛视觉模拟评分（visual analogue scale,VAS）及其改善率对两组的临床疗效进行评价;同时摄颈椎正侧位、过屈过伸位X线片,测量颈椎前凸角、手术节段和相邻节段椎间活动度、椎间隙角度、假体前后缘与椎体前后缘距离及异位骨化数并进行统计学对比分析。结果两组患者年龄、性别、手术时间和出血量之间差异无统计学意义（P〉0.05）;Prodisc-C组术前JOA、NDI、颈肩痛VAS、上肢痛VAS、颈椎前凸角及手术节段椎间隙角分别为（10.3±1.4）、（15.2±5.5）、（6.2±2.1）、（4.1±1.4）、（10.0±2.1）°、（3.7±4.5）°,术后末次随访（15.8±5.4）、（3±1.2）、（2.9±1.8）、（1.8±0.8）、（16.6±3.6）°、（5.4±2.1）°;DCI组术前JOA、NDI、颈肩痛VAS、上肢痛VAS、颈椎前凸角及手术节段椎间隙角分别为（9.5±1.3）、（15.6±16.3）、（6.4±2.0）、（4.5±1.4）、（14.9±3.5）°、（3.1±2.2）°,术后末次随访分别为（16.2±5.8）、（2.9±1.3）、（2.6±1.7）、（1.9±1.1）、（22.3±4.6）°、（6.4±2.3）°;两组患者术后6个月和末次随访与术前比较,差异均有统计学意义（P〈0.01）,但两组间术前及术后末次随访时差异无统计学意义（P〉0.05）;两组患者术前、术后6个月及末次随访时对比,手术节段椎间隙高度、手术节段和相邻节段椎间活动度差异无统计学意义（P〉0.05）。Prodisc-C组术后末次随访发现3例异位骨化,2例假体前移1 mm,DCI组未出现异位骨化和假体移动。结论 Prodisc-C人工颈椎间盘与DCI治疗颈椎病均能保留颈椎活动度,恢复和维持椎间隙高度和颈椎生理弧度,早中期疗效满意。

Objective To evaluate the clinical and radiological outcomes of cervical disc arthroplasty by Prodisc-C versus dynamic cervial implant（ DCI） in the treatment of cervical spondylopathy. Methods All cervical spondylopathy cases undergoing cervical disc arthroplasty by Prodisc-C or dynamic cervial implant between February 2011 and February 2013 were analyzed retrospectively. There were 16 patients in anterior cervical disc arthroplasty group（ male 8, female 8）. Age averaged 44 years（ range： 32-54 years）. There were 10 cases with cervical spondylotic myelopathy, and 6 cases with radicular spondylosis. In dynamic cervical implant group were 10 cases（ male 6, female 4）. Age averaged 44.5 years（ range： 33-55 years）. There were 7 cases of cervical spondylotic myelopathy, and 3 cases of radicular spondylosis. Parameters as gender, age, operation time and blood loss of all the patients were analyzed. The patients were followed 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. Neck disability index（ NDI）, Japanese Orthopaedic Association（ JOA） Score and Visual Analogue Scale（ VAS） were used to evaluate the clinical outcomes of the two groups. Anterioposterior and lateral X-ray, hyperextension and hyperflexion X-ray films before and after surgery were analyzed and cervical lordosis, the height of disc, range of motion, the distance between implant and wedge of vertebrae and heterotopic ossification were measured. All statistics were done by SPSS 12.0. Results In both groups, there were no significant differences in the age, gender, operation time and blood loss（ P〈0.05）. In cervical disc arthroplasty group, the preoperative JOA, NDI, VAS of neck pain and upper extremity pain score and cervical lordosis, intervertebral disc angle were（ 10.3±1.4）,（ 15.2±5.5）,（ 6.2±2.1）,（ 4.1±1.4）,（ 10.0±2.1） °,（ 3.7±4.5） ° and at final follow-up after operation were（ 15.8±5.4）,（ 3±1.2）,（ 2.9±1.8）,（ 1.8±0.8）,（ 16.6±3.6） °,（ 5.4±2.1） °. In DCI group preoperatively were（ 9.5±1.3）,（ 15.6±16.3）,（ 6.4±2.0）,（ 4.5±1.4）,（ 14.9±3.5） °,（ 3.1±2.2） ° vs. postoperatively（ 16.2±5.8）,（ 2.9±1.3）,（ 2.6±1.7）,（ 1.9±1.1）,（ 22.3±4.6） °.（ 6.4±2.3） ° In the two groups, postoperative conditions were significantly improved（ P〈0.01）. There were no significant differences preoperatively and postoperaticely in the follow-up in 2 groups（ P〉0.05）. There were no significant differences in the height of operation segment and the adjacent segment, and the range of motion at any time in the two groups（ P〉0.05）. Prosthesis antedisplacement of 1mm occurred in 2 cases, heterotopic ossification occurred in 3 cases in cervical disc arthroplasty group, while DCI group was normal. Conclusions Cervical disc arthroplasty and dynamic cervical implant can retain the range of motion, recover and maintain the height of disc and cervical lordosis in the treatment of cervical spondylopathy with satisfactory early and mid-term results.