Bryan人工椎间盘置换术后置换节段活动度情况及影响因素分析

Mobility of Replaced Segments and Influencing Factors after Artificial Intervertebral Disc Replacement with Bryan

目的探讨Bryan人工椎间盘置换术后置换节段活动度情况及影响其活动度的相关因素。方法选取2015年1月至2016年5月于我院骨科行单节段Bryan人工颈椎间盘置换术的48例患者作为研究对象,采用系统性回顾法分析其临床资料,分析所有患者术前术后影像学资料,观察比较拟置换节段不同椎间隙高度、不同活动度、脊柱功能单位与上位椎体不同高度比值及脊柱功能单位不同后凸角度间其置换节段术后的活动度,且分析其活动度与上述变量间的关系。结果(1)所有患者术后活动度较术前均有明显增大,且术后椎间隙高度比值>0.80的患者活动度增大程度大于比值≤0.80的患者,术前置换节段活动度>6°患者术后活动度增大程度大于≤6°患者,FSU与上位椎体高度比值(术前/术后)<0.05患者其活动度增大程度明显大于≥0.05患者,差异具有统计学意义(P<0.05),但置换节段FSU不同角度(术后/术前)患者间期术后活动度比较无明显差异(P>0.05);(2)椎间隙高度比值(>0.80)、术前置换节段活动度(>6°)及FSU与上位椎体高度比值(术前/术后<0.05)为增大Bryan人工椎间盘置换术后置换节段活动度的独立影响因素。结论 Bryan人工椎间盘置换术可明显改善置换节段活动度,且椎间隙高度比值、术前置换节段活动度及FSU与上位椎体高度比值为影响其术后活动度的相关因素。

Objective To investigate the mobility of replaced segments after Bryan artificial disc replacement and the factors that influence mobility.Methods Forty-eight patients with single-segment Bryan cervical disc arthroplasty underwent orthopedic surgery in our department between January 2015 and May 2016.The clinical data was analyzed retrospectively.All the patients were followed up.The preoperative and postoperative radiographic data of all the patients was analyzed.The height of different intervertebral spaces,different degrees of mobility,the ratio of spine functional units to the height of the upper vertebral body and the different functional segments of the spine were compared.The relationships between mobility and the above-mentioned variables were analyzed.Results（1） All the patients had significantly greater postoperative mobility.Pateints with a postoperative intervertebral space height ratio 〉0.80 had a greater mobility than those with a ratio ≤ 0.80.Patients with a preoperative replaced segment mobility 〉6 ° had an increased postoperative mobility compared with those with mobility 〈6 °（P〈 0.05）.Patients whose ratio of FSU to the height of the superior vertebral body（preoperative/postoperative） was above 0.05 had significantly a greater mobility than those with a ratio ≥0.05.The difference was statistically significant（P〈0.05）.However,there was no significant difference in the postoperative range of FSU（P 〉0.05） at different angles（postoperative/preoperative）.（2） A ratio of intervertebral space to height 〉0.80,a range of postoperative mobility 〉6 °,and a ratio of FSU to the height of the superior vertebral body 〈0.05（preoperative/postoperative） were independent factors that influenced the mobility of replaced segments after Bryan disc replacement.Conclusion Bryan artificial disc replacement can significantly improve the mobility of replaced segments.The ratio of the intervertebral space to height,the preoperative mobility of replaced segments and the ratio of FSU to the height of the superior vertebral body are factors that influence the postoperative range of motion.