人工颈椎间盘置换联合前路减压融合术治疗多节段颈椎病的临床疗效分析

Clinical study of artificial cervical disc replacement combined with anterior cervical decompression and fusion for multilevel cervical spondylosis

目的探讨人工颈椎间盘置换联合前路减压融合术治疗多节段颈椎病的临床疗效。方法回顾性分析2009年1月~2013年4月因多节段颈椎病于我院行人工颈椎间盘置换联合前路融合术的18例患者临床资料,男7例,女11例;年龄37~59岁,平均47.1岁;11例患者行人工颈椎间盘置换联合椎间盘切除减压融合术,7例患者行人工颈椎间盘置换联合椎体次全切减压融合术。采用日本整形外科协会评分(Japanese orthopaedic association,JOA)、颈椎功能残障指数(neck disability index,NDI)、疼痛视觉模拟评分(visual analogue scale,VAS)评价临床疗效;行颈椎正侧位、功能位X线片及颈椎CT三维重建扫描,分别测量置换节段、手术相邻节段及颈椎整体活动度,并观察融合节段融合率、内固定位置及异位骨化情况。结果术后随访18~54个月,平均26.3个月,术后各随访点患者JOA、NDI、VAS评分均较术前显著改善(P<0.05);术后24个月时置换节段活动度(8.37°±2.77°)与术前(8.23°±3.36°)相比差异无统计学意义(P>0.05),颈椎整体活动度(41.71°±6.99°)较术前(44.91°±9.48°)显著减小,置换邻近节段活动度(9.16°±2.72°)与术前(9.41°±2.72°)相比差异无统计学意义(P>0.05),融合邻近节段活动度(9.43°±2.6°)较术前(8.18°±2.42°)显著增加(P<0.05);术后12个月融合节段融合率100%,术后各随访点未观察到内植物松动、移位及异位骨化等并发症。结论人工颈椎间盘置换联合前路减压融合术治疗多节段颈椎病可有效缓解疼痛、改善神经功能、维持颈椎生理活动度,获得满意临床疗效。

Objective To explore the clinical efFects of artificial cervical disc replacement combined with anterior cervical decompression with fUsion in treatment of patients with multi-level cervical spondylosis. Methods A total of 18 patients who underwent artificial cervical disc replacement combined with anterior cervical decompression and fusion were eligible for this respectively reviewing study from Jun 2009 to Apr 2013, including 7 males and 11 females, with a mean age of 47.1 （37 ？59 years）. Among these 18 patients underwent hybrid surgery （HS）, 11 cases underwent artificial cervical disc replacement （ACDR） combined with anterior cervical disectomy and fiision （ACDF）, 7 cases underwent ACDR combined with anterior cervical corpectomy and fiision （ACCF）. Clinical outcomes were determined by Japanese orthopaedic association （JOA）,neck disability index （NDI） and visual analogue scale （VAS）. Radiographic parameters including angular range of motion （ROM） of arthroplasty, C7 and adjacent segments were measured by X-ray. Fusion rate,implant-related complication and heterotopic ossification were also observed by CT scan. Results All patients received 18 to 54 months follow-up, with an average of 26.3 months. The JOA, NDI and VAS scores were significantly decreased during the follow up periods compared with pre-operation respectively （P〈0.05）. At 24 months post-operation, compared with pre-operation, ROM of arthroplasty （8.37°±2.77° vs 8.23°±3.36°）, arthroplasty adjacent segment （9.16°±2.72° vs 9.41.± 2.72.）bothshowednosignificantdifference （P〉0.05）; howeverROMofC2？C7 （41.71.± 6.99° vs44.91.± 9.48.） and fUsional adjacent segment （9.43. ±2.6.vs 8.18.± 2.42. ）were detected with significant difference （P〈0.05）. At 12 month post-operation, all segments underwent fiision surgery received solid fiision; during postoperative follow-up implant- related complication and heterotopic ossification were not detected. Conclusion Artificial cervical disc replacement com-bined with anterior cervical decompression and fusion is a safe and effective alternative for multilevel cervical spondylosis in terms of satisfactory pain relief, NDI recovery and cervical ROM preservation.