Bryan人工颈椎间盘置换术后X线评估

Role of X-ray in the assessment of Bryan cervical disk replacement

目的评估X线片在人工颈椎间盘置换术后随访中的价值。方法回顾性分析2003年12月至2005年5月,北京积水潭医院脊柱外科行Bryan人工颈椎间盘置换术并于2008年1-10月接受随访的病例33例。其中男25例,女8例;年龄25-70岁,平均47.2岁。单节段人工颈椎间盘置换23例,双节段人工颈椎间盘置换10例,共43个手术节段。对其术前及术后随访所摄的颈椎正位、侧位、过屈位及过伸位X线片进行影像学分析评估。结果本组随访时间36-52个月,平均43个月。43个颈椎间盘置换节段X线片显示,人工椎间盘假体前后径小于椎体前后径14个（32.6%）;人工椎间盘假体发生移位3个（7.0%）;颈椎间盘置换节段可见异常骨化或骨赘16个（37.2%）;术前与术后颈椎整体曲度、颈椎间盘置换节段曲度、颈椎间盘置换节段活动度及颈椎间盘置换节段邻近椎间盘退变的测量评估,差异均无统计学意义（P〉0.05）。结论Bryan人工颈椎间盘置换手术能够较好地保持颈椎的生理曲度和活动功能,并可一定程度上防止邻近椎间盘退变,但部分病例存在假体移位、异位骨化等现象,术前适宜的病例筛选及规范手术操作有助于避免此类并发症的发生,其远期疗效仍有待长期大样本量随访研究。

Objective To evaluate the value of X-ray plain film in the follow-up of Bryan cervical disk replacement. Methods A retrospective analysis was made in 33 cases accepting Bryan cervical disk replacement from December 2003 to May 2005, and all were followed up from January to October 2008 in Beijing Jishuitan Hospital. X-ray Images before and after operations were compared and evaluated. There were 25 males and 8 females（ aged 25- 70 years, mean age 47.2 years）. Single segment replacement： 23 cases; double segment replacement： 10 cases; a total of 43 surgical segments. Cervical anteroposterior, lateral, hyperflexion and hyperextension X-ray films were analyzed in the preoperative and postoperative follow-up. Results Follow-up lasted for 36- 52 months（ mean： 42.97 months）. In this group of 43 Bryan cervical disk replacement segments, the sagittal diameter of the Bryan cervical disc was less than the vertebra： 14 segments（ 32.6%）. Displacement of Bryan cervical disc was seen in 3 segments（ 7.0%）; osteophytes and degeneration were seen in 16 segments（ 37.2%）. Cervical lordosis, segmental lordosis, disk motion, and the degeneration of adjacent discs were assessed with no statistical significance before and after the operation（ P 〉0.05）. Conclusions Bryan cervical disk replacement can maintain the lordosis and disk motion of the cervical spine, and can prevent the adjacent disc degeneration. There are displacement and ossification in some cases, but can be avoided by proper patients＇ selection and standardized operation. Long-term effects remain to be studied by large sample data.