探讨ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合治疗颈椎病的临床疗效

To evaluate clinical outcomes of ProDisc-C cervical disc replacement versus fusion for cervical spondylosis

目的 探讨ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合（ACDF）治疗单节段椎间盘退变引起的脊髓或神经根颈椎病的临床疗效。方法 自2010年10月至2012年年8月武汉大学人民医院收治的46例颈椎病病例,随机进行分组,其中实验组：24例行ProDisc-C置换术,对照组：22例行ACDF。评价指标主要如下：两组手术时间及术中出血量;两组术前、术后3、12月VAS评分,JOA评分,手术邻近节段活动度,颈椎活动度（ROM）以及术后并发症。结果 46例患者全部获得平均12个月（8~18个月）随访。两组手术时间及术中出血量无统计学差异（P〉0.05）。两组术后VAS评分,JOA评分均较术前明显提高（P〈0.05）,两组差异无统计学意义（P〉0.05）。试验组整个下颈椎的活动度及邻近节段活动度各个随访时段与术前相比无变化（P〉0.05）;对照组在术后3个月整个下颈椎活动度较术前相比有统计学差异（P〈0.05）,术后12个月时逐渐恢复正常,术后12个月邻近节段活动度较术前有统计学差异（P〈0.05）。其中对照组术后出现3例吞咽困难。结论ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合（ACDF）治疗单节段椎间盘退变引起的脊髓或神经根颈椎病在中短期随访中临床效果满意,人工颈椎间盘置换术能有效保留颈椎活动度,减少临近节段的退变,并且术后吞咽困难发生率较低。

Objective To prospectively compare the clinical effects of ProDisc-C cervical disc replacement with those of anterior cervi-cal discectomy and fusion （ ACDF） in the treatment of single-level cervical spondylotic myelopathy or radiculopathy.Methods From the Department of Orthopaedics in Renmin Hospital of wuhan University within the period of October 2010 to August 2012,A total of 46 patients with single-level cervical spondylotic myelopathy or radiculopathy were enrolled in this study .They were randomly assigned to ProDisc-C artificial cervical disc replacement group （ arthroplasty group：24 patients） and anterior cervical discectomy and fusion group （fusion group：22 patients）.Operation time,blood loss were compared between the 2 groups.Visual analogue scale（VAS）,Japanese Orthopedics Association（ JOA） score,Range-of-motion of cervical overall and adjacent intervertebral area near the intervertebral space were evaluated preoperatively and 3,12,months postoperatively.Results A total of 46 patients（100%） were followed up for an aver-age 12 months（range,6~24）.No difference was found in the operation time,intraoperative blood loss between 2 groups（P〉0.05）. VAS and JOA scores were apparently improved after surgery compared with before surgery in each group（P〈0.05）.The improvement in the VAS and JOA scores were equivalent at each follow-up point between the two groups （P〉0.05）.In ProDisc-C group,pre-and postoperative motion of cervical overall and adjacent intervertebral area near the intervertebral space are remained unchanged at any of the follow-up time （P〉0.05）.In ACDF group,motion of cervical overall decreased in 3 months after operation but gradually recovered to preoperative level in12 months after operation.Motion of adjacent intervertebral area increased in 12 months （P〈0.05）.There are 3 cases with dysphagia after operation in ACDF group.Conclusion ProDisc-C artificial cervical disc replacement can achieve similar clinical improvement compared with traditional ACDF for treatment of single segment disc degeneration in Mid term follow up.Artificial cervical disc replacement can effectively retain the cervical range of motion,reduce the degeneration of adjacent segments and the inci-dence of postoperative dysphagia.