人工间盘尺寸大小对颈椎人工间盘置换效果的影响

Influence of the artificial disc size on cervical artificial disc replacement

背景:人工间盘尺寸与椎体终板大小并不完全一致,而目前关于人工间盘大小对人工间盘置换效果的影响还未明确。目的:探讨Bryan间盘大小对颈椎人工间盘置换效果的影响。方法:纳入2003年12月至2007年12月因颈椎退行性疾病行单节段Bryan人工间盘置换的患者71例,平均年龄(45.90±8.12)岁,均随访10年以上。在X射线侧位片上测量人工间盘大小,人工间盘大小=(Bryan人工间盘端板矢状径×2y(置换节段上终板矢状径+置换节段下终板矢状径)×100%。分别于术前、术后3个月及末次随访时拍摄X射线片,测量置换节段活动度。并于术前、术后评估临床疗效,包括JOA评分、颈椎功能障碍指数和Odom’s评分。并对不同人工间盘大小(≥95%及<95%组)患者的观察指标进行统计对比分析。结果与结论:(1)人工间盘大小比例≥95%组49例,人工间盘大小比例<95%组22例;(2)术后3个月随访时,人工间盘大小<95%组置换节段活动度显著小于≥95%组(P<0.01);末次随访时,人工间盘大小<95%组置换节段活动度小于≥95%组(P<0.05);(3)末次随访时,人工间盘大小<95%组JOA评分改善率为(70.65±32.58)%;人工间盘大小≥95%组JOA评分改善率为(68.83±38.85)%,2组间差异无显著性意义(P>0.05);(4)末次随访时,人工间盘大小<95%组NDI减低(10.82±7.50)%;人工间盘大小≥95%组末次随访时NDI减低(12.61±8.51)%,2组间差异无显著性意义(P>0.05);(5)末次随访时,人工间盘大小<95%组Odem’s评分优10例(45%),良9例(41%),可3例(14%);人工间盘大小≥95%组Odem’s评分优26例(53%),良20例(41%),可3例(6%),2组间差异无显著性意义(P>0.05);(6)结果表明,2组不同大小的颈椎人工间盘置换后均获得了良好的功能恢复,但人工间盘过小会对置换节段活动度产生影响,应尽量避免置入的人工间盘与终板比例<95%。

BACKGROUND:The size of artificial disc is not exactly identical to cervical vertebral endplate.However,the effect of implant size on cervical disc replacement has not yet been clearly identified.OBJECTIVE:To evaluate the effect of Bryan disc size on cervical artificial disc replacement.METHODS:Totally 71 patients with cervical degenerative disease underwent single-level Bryan disc replacement from December 2003 to December 2007 were enrolled.The average age was(45.90±8.12)years old,and all patients were followed up for more than 10 years.The artificial disc size was measured using lateral X-ray films,and expressed as(Bryan artificial disc’s footprint sagittal diameter×2)/(upper endplate sagittal diameter+lower endplate’s sagittal diameter)×100%.X-ray films were photographed to measure motion range of the treated segment before surgery,3 months after surgery,and during final follow-up.Clinical outcomes,including Japanese Orthopaedic Association score,Neck Disability Index and Odom’s scores,were evaluated before and after operation.Observational indexes of different disc sizes(≥95%and<95%groups)were compared and analyzed.RESULTS AND CONCLUSION:(1)There were 49 patients in the≥95%group and 22 patients in the<95%group.(2)At 3-month follow-up,range of motion was significantly smaller in the<95%group than in the≥95%group(P<0.01).At the final follow-up,range of motion was significantly smaller in the<95%group than in the≥95%group(P<0.05).(3)At final follow-up,improvement rate of Japanese Orthopaedic Association score was(70.65±32.58)%in the<95%group and(68.83±38.85)%in the≥95%group,and no significant difference was detected between the two groups(P>0.05).(4)At final follow-up,Neck Disability Index decreased by(10.82±7.50)%in the<95%group,and(12.61±8.51)%in the≥95%group,and no significant difference was detected between the two groups(P>0.05).(5)At final follow-up,Odem’s score results showed excellent in 10 cases(45%),good in 9 cases(41%)and average in 3 cases(14%)in the<95%group;and excellent in 26 cases(53%),good in 20 cases(41%)and average in 3 cases(6%)in the≥95%group,and no significant difference was detected between the two groups(P>0.05).(6)Results suggest that different sizes of artificial disc replacement have obtained good functional recovery,but small artificial disc may impact the range of motion.We should try to avoid placing the artificial disc smaller than 95%.