人工颈椎间盘置换术患者手术体位安置对策

Countermeasure of surgical position for patients of cervical artificial disc replacement

目的总结人工颈椎间盘置换手术体位的安置方法及要点。方法收集四川大学华西医院2015年1—12月颈椎外科收治的颈椎退行性变并行人工颈椎间盘置换患者102例，根据其置换节段、数量和手术方式等判断是否达到手术体位的最佳安置。结果本组患者手术体位均符合置换要求，术中显露顺利，出血量少，减压视野清晰、彻底，置换假体位置安放良好，术后无并发症发生，均在术后5—7d痊愈出院，6-18个月随访无假体位置偏移、脱出，恢复了颈椎理想生理前凸。结论根据置换不同节段安置颈椎保持在较术前中立位轻度稍后伸的位置，有利于术中人工颈椎间盘合理位置的顺利安放，促进术后早期颈椎维持正常生理前凸，减少术后颈肩疼痛的发生率。

Objective To make a conclusion about the methods and main points of surgical position for cervical artificial disc replacement （CADR）. Methods We collected the data from January to December 2015 in West China Hospital of Siehuan University. It included 102 patients in the surgical group of cervical spine, which were cervical vertebra degeneration and doing CADR according to the segment, quantity of the replacement and whether belonged to hybrid surgical method, then we analyzed and determined how to achieve the desired surgical position. Results The surgical positions of the patients in this group all conformed to the requirements of the replacement and gave intraoperative excellent exposure and less blood loss, made the vision of decompression clear and thorough, made the position of replacement prosthesis great. There were no postoperative complications. The patients all healed and were discharged in 5 to 7 days after operation. There was no position offset of prosthesis and no extrusion in the following 6 to 18 months. It restored the ideal physiological lordosis of the cervical spine. Conclusions According to the different segment of the replacement, we analyze and remain the location of the preoperative cervical spinal neutrality and a bit of extension which make the artificial cervical disc in favor of being well placed during an operation and promote cervical spine to maintain normal physiological lordosis during early post-operation, and greatly reduce the incidence of postoperative pain of neck and shoulder.