Discover人工颈椎间盘置换治疗颈椎间盘退变性疾病的早中期疗效及并发症分析

Early and mid-term outcomes and complications after Discover cervical artificial disc replacement for cervical degenerative disc disease

[目的]总结分析Discover人工颈椎间盘置换治疗颈椎间盘退变性疾病的早中期疗效及并发症。[方法]回顾性分析2011年3月~2014年11月使用Discover人工颈椎间盘置换术治疗颈椎间盘退变性变患者共92例,男56例,女36例;年龄27~68岁,平均49.4岁。采用疼痛视觉模拟评分法（visual analogue scale,VAS）评定疼痛症状改善情况,采用日本骨科协会（Japanese Orthopedics Association,JOA）脊髓功能评分（17分法）及颈椎功能障碍指数（neck disability index,NDI）评价术后功能改善情况。行颈椎正侧及动力位X线片检查测定并比较手术前后手术节段椎间盘平均高度（disc height,DH）、手术节段脊柱功能单位（functional spinal unit,FSU）Cobb角及C_（2~7）Cobb角的变化情况。总结术中及术后并发症,分析其原因。[结果]92例患者中89例获得完整随访,随访时间（3~47）个月,平均26.5个月。末次随访时患者的VAS、JOA及NDI评分均较术前明显改善（P〈0.05）。术前手术节段DH为（4.41±0.76）cm,术后为（6.29±0.38）cm,差异有统计学意义（P〈0.05）;术前FSU Cobb角为（11.00±4.36）°,术后为（11.67±5.17）°,差异无统计学意义（P=0.854）;术前C2~7Cobb角为（42.89±14.81）°,术后为（46.56±11.10）°,差异无统计学意义（P=0.418）。9例（10.1%）患者出现术后并发症,其中2例术后出现假体轻度前移,5例出现异位骨化（heterotopic ossification,HO）,2例出现假体轻度前移位合并HO,但均无相应临床症状,未行处理。[结论]Discover人工颈椎间盘置换治疗颈椎退变性疾病的早中期有效性及安全性肯定,但存在一定并发症风险,远期效果仍待观察。

[Objective] To summarize and analyze the early and mid- term efficiency and complications after Discover cervical artificial disc replacement for cervical degenerative disc disease. [Methods] From March 2011 to November 2014,92 cases with cervical degenerative disc disease were treated with Discover cervical artificial disc replacement. There were 56 male patients and 36 female patients,the average age was 49. 4 years. The clinical results were assessed by visual analog scale（ VAS） of pain on cervical and upper limbs,Japanese Orthopedic Association（ JOA） score and neck disability index（ NDI）.The disc height（ DH）,the functional spinal unit（ FSU） angle of the operated segments and the Cobb angle of C2 ~ 7were recorded by lumbar X ray and dynamic X ray to assess the biomechanical changes before and after operation. Intraoperative and postoperative complications were observed and then the causes were analyzed. [Results] A total of 89 cases were followed up and the average time was 26. 5 months（ range,3 ~ 47 months）. At the final follow- up,the VAS,JOA and NDI scores increased significantly than preoperative ones（ P〈0. 05）. DH of the operated segments was higher than preoperative one [（ 6. 29 ±0. 38） cm vs（ 4. 41 ± 0. 76） cm,P〈0. 05],while the FSU Cobb angle and C（27） Cobb angle were（ 11. 67 ± 5. 17） cm and（ 46. 56 ± 11. 10） cm,showing no significant difference compared with preoperative angles [（ 11. 00 ± 4. 36） cm and（ 42. 89± 14. 81） cm]（ P = 0. 854 and P = 0. 418,respectively）. The complication rate was 10. 1%（ 9 /89）,in which 4 cases with mild anterior migration of the prosthesis,5 cases with heterotopic ossification（ HO） and 2 cases with both of them after surgery,but no symptoms was found and on treatment was given. [Conclusion] The application of Discover cervical artificial disc re-placement for cervical degenerative disc disease has achieved good early and mid- term effects,but with a certain risk of complications. Further study should be conducted to determine the long term outcome.