单双节段颈椎人工间盘置换术长期疗效比较

Long-term Efficacy in Single-level and Two-level Cervical Artificial Disc Replacement

目的探讨单节段与双节段颈椎人工间盘置换术对治疗颈椎退行性疾病长期临床疗效的影响。方法回顾性分析我院2003年12月至2007年12月间86例患者101个节段行单双节段Bryan人工间盘置换术且随访10年以上患者的临床资料,其中男51例,女35例;平均年龄(53.9±9.3)岁。按手术节段数患者分为两组:单节段组71个节段,双节段组30个节段。评估患者的临床功能指标,包括日本骨科学会(Japanese orthopaedic association,JOA)评分、颈椎功能障碍(neck disability index,NDI)及Odom's标准;影像学指标:包括颈椎整体活动度(range of motion,ROM)、手术节段ROM、手术节段Cobb角。比较两组患者临床功能与影像学评估指标间的差异。结果单节段组颈椎整体ROM术前为(45.90±15.18)°,末次随访时为(46.31±13.03)°;手术节段ROM术前为(9.67±4.54)°,末次随访时为(8.63±5.34)°;手术节段Cobb角术前为(2.13±1.32)°,末次随访时为(1.23±1.92)°。双节段组颈椎整体ROM术前为(40.14±11.59)°,末次随访时为(38.33±12.31)°;手术节段ROM术前为(9.10±4.00)°,末次随访时为(6.51±4.61)°,手术节段Cobb角术前为(3.09±2.15)°,末次随访时为(0.44±4.62)°。单节段组患者JOA改善率为(69.40±36.80)%,NDI下降(12.06±8.20)%,Odom's标准优良率为91.5%。双节段组患者JOA改善率为(59.44±59.80)%,NDI下降(12.53±9.47)%,Odom's标准优良率为80.0%。单节段组患者末次随访时颈椎整体活动度优于双节段组(P<0.05),其余指标差异无统计学意义。结论单双节段Bryan颈椎人工间盘置换术用于治疗颈椎退行性疾病具有较为满意的长期疗效,单节段Bryan人工间盘置换术后远期颈椎整体活动度优于双节段Bryan人工间盘置换术。

Objective To evaluate the influence of long-term efficacy in single-level and two-level Bryan artificial disc replacement for treating cervical degenerative disease.Methods Weretrospective analyzed 101 levels in 86 patient sunderwent single-level or two-level Bryan artificial disc replacement in our hospital between December 2003 and December 2007,and followed up for more than 10 years.The mean age was（53.9±9.3）years including 51 males and 35 females.According to the number of the operation level,the patients were divided into two groups：71 levels in group of single-level and 30 levels in group of two-levels.Clinical evaluation indexes included JOA score,NDI index and Odom＇s standard.Radiographic evaluationindexes included theglobal and segmental range of motion（ROM）,segmental COBB＇s angle.Results The preoper ative global ROM was（45.90±15.18）°,and was（46.31±13.03）°at last fellow-up.The preoperative segmental ROM was（9.67±4.54）°and was（8.63±5.34）°at last follow-up.The preoperative segmental COBB＇s angle was（2.13±1.32）°,and was（1.23±1.92）°at last fellow-up.The preoper ative global ROM was（40.14±11.59）°,and was（38.33±12.31）°at last fellow-up.The preoperative segmental ROM was（9.10±4.00）°,and was（6.51±4.61）°at last fellow-up.The preoperative segmental COBB＇s angle was（3.09±2.15）°,and was（0.44±4.62）°at last fellow-up.In single-level group,the improvement rate of JOA score was（69.40±36.80）%,NDI decreased by（12.06±8.20）% and the satisfaction rate of Odom＇s standard was 91.5%.In two-level group,the improvement rate of JOA score was（59.44±59.80）%,NDI% decreased by（12.53±9.47）% and the satisfaction rate of Odom＇s standard was 80.0%.The global ROM in single-level group was higher than two-level group（P〈0.05）.The difference of other indexes was not statistically significantin two groups.Conclusion Both single-level and two-level Bryan cervical artificial disc replacement have the satisfied long-term efficacy in treating cervical degenerative diseases,the postoperative global ROM after long-term of single-level group is higher than those of two-level group.