人工椎间盘置换术与颈椎融合术治疗神经根型颈椎病手术疗效的比较

Comparison of cervical disc replacement versus decompression and fusion for treatment of cervical radiculopathy

[目的]比较分析人工椎间盘置换术（cervical total disc replacement,CDTR）和颈椎前路减压植骨融合术（anterior cervical discectomy and fusion,ACDF）治疗神经根型颈椎病手术疗效。[方法]分析2012年9月-2014年1月长征医院骨科收治的接受CDTR术或ACDF术治疗的神经根性颈椎病患者73例,所有病例平均随访1.4年,比较两组患者末次随访VAS（Visual Analogue Score,视觉模拟评分法）、NDI（Neck Disabilitv Index,颈部伤残指数）、SF-36PCS（SF-36 physical component summary,健康调查简表生理部分）、SF-36MCS（SF-36 mental component summary,健康调查简表心理部分）及手术相邻节段活动度（ROM）。[结果]CDTR组术较ACDF组术出血量少、手术时间短[出血量分别为：（184.9±40.5）ml,（226.1±53.9）ml,P〈0.01;手术时间分别为：（135.5±14.0）min,（145.2±15.1）,P〈0.01]。随访期间未发现假体及椎间融合器松动脱落移位等。两组术后症状均比术前有明显改善。ACDF组与CTDR组术前及末次随VAS、NDI、SF-36PCS、SF-36-MCS比较差异均无统计学意义（P〉0.05）;ACDF组末次随访手术相邻上、下节段活动度与术前相比差异有统计学意义（P〈0.05）;CTDR组术前与术后手术节段活动度相比无明显差异,手术相邻上节段与下节段活动度与术前相比较均未见明显差异。[结论]两种手术方式术后疗效无明显差异,CDTR组不仅保留了手术节段的运动功能同时减少了临近节段影响。CDTR治疗神经根型颈椎病是一种切实可行的手术方式。

To compare outcomes of cervical radiculopathy treated by cervical total disc replacement（ CTDR）with Discover artificial disc versus anterior cervical decompression and fusion（ ACDF）. [Methods] A prospective study was conducted on 73 patients with cervical radiculopathy,who were surgically treated by CTDR or ACDE in Orthopedic Department of Changzheng Hospital from Sept 2012 to Jan 2014. Visual analogue scale（ VAS）,neck disability index（ NDI）,SF- 36 PCS,（ PCS,physical component summary）,SF- 36- MCS（ MCS,mental component summary）,and range of motion（ ROM） of involved and adjacent segments were used to evaluate and compare the outcomes of the two groups. [Results] Blood loss during operation in the CTDR group was significantly less than that in the ACDF group（ 184. 9 ± 40） ml versus（ 226. 1 ± 53. 9） ml,P〈0. 01. Additionally,operative time in the CTDR group was also considerably shortened compared to that in the ACDF group（（ 135. 5 ± 14. 0） min versus（ 145. 2 ± 15. 1） min,P〈0. 01）. During the follow- up period,no prosthetic or interbody-fusion implant loose and displacements occurred in any patient. Significant reliefs of symptoms were noted in both the CTDR and ACDF groups after operation. Compared between the two groups,there were no significant differences before operation and at the latest follow up in VAS,NDI,SF- 36 PCS and SF- 36- MCS（ P〈0. 05）. However,compared with those before operation,ROM of the involved segment,upper and lower adjacent segments in the CTDR group were left unchanged at the final follow up,while ROM of upper and lower adjacent segments in the ACDF group changed significantly（ P〈0. 05）. [Conclusion] Despite no significant differences between CTDR and ACDF in terms of clinical results,Discover artificial disc replacement not only retains functional motion of the involved segment,but also has minimal impact on the adjacent segments. Discover artificial disc replacement is a feasible surgical approach for treatment of cervical radiculopathy.