Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响

Effect of Bryan Cervical Disc Prosthesis Replacement on the Curative Effect and the Biomechanics of the Cervical Spine in Patients with Cervical Spondylotic Myelopathy

目的:探讨Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响。方法:选取2015年1月到2016年12月期间在我院接受治疗的脊髓型颈椎病患者48例,根据手术方式的不同将其分为植骨融合组(25例)和假体置换组(23例),其中植骨融合组采用颈椎前路减压植骨融合术进行治疗,假体置换组采用Bryan颈椎间盘假体置换术进行治疗。比较两组患者的日本骨科协会(JOA)颈椎评分、颈椎功能障碍指数(NDI)评分、视觉模拟疼痛量表(VAS)评分、颈椎生理曲度、颈椎活动度、手术节段活动度、上邻近节段活动度、下邻近节段活动度,并比较两组患者的并发症情况。结果:术后12个月假体置换组的NDI评分明显低于植骨融合组(P<0.05);术后6个月、术后12个月植骨融合组的颈椎活动度低于假体置换组(P<0.05);术后1个月、术后3个月、术后6个月、术后12个月假体置换组的手术节段活动度高于植骨融合组(P<0.05);术后12个月植骨融合组的上邻近节段活动度、下邻近节段活动度高于假体置换组(P<0.05);两组患者随访期间颈部轴性症状发生率比较差异有统计学意义(P<0.05)。结论:与颈椎前路减压植骨融合术比较,Bryan颈椎间盘假体置换术对脊髓型颈椎病患者的远期疗效更佳,可更好的改善患者的颈椎生物力学,降低颈部轴性症状发生率,值得临床推广应用。

Objective: To investigate the effect of Bryan cervical disc prosthesis replacement on the curative effect and the biomechanics of the cervical spine in patients with cervical spondylotic myelopathy. Methods: 48 patients with cervical spondylotic myelopathy who were treated in our hospital from January 2015 to December 2016 were selected. According to the different operation methods, they were divided into bone graft fusion group(25 cases) and prosthetic replacement group(23 cases). The bone graft fusion group was treated with anterior cervical decompression and fusion, the prosthesis replacement group was treated with Bryan cervical disc prosthesis replacement. The scores of Japanese Association for Department of orthopedics(JOA), neck disability index(NDI), visual analogue scale(VAS), cervical physiological curvature, cervical spine activity, surgical segment activity, upper adjacent segment activity,lower adjacent segment activity were compared between the two groups, and the complications of the two groups were compared.Results: The NDI score in the prosthetic replacement group at 12 month after operation was significantly lower than that of the bone graft fusion group(P<0.05). The cervical spine activity in the bone graft fusion group at 6 months, 12 months after operation were lower than those of the prosthetic replacement group(P <0.05). The surgical segment activity in the prosthetic replacement group at 1 month, 3 months, 6 months, 12 months after operation were significantly higher than those of the bone graft fusion group(P<0.05). The upper and lower adjacent segment activity in the the bone graft fusion group at 12 months after operation were higher than those of the prosthetic replacement group(P<0.05). There was significant difference in the incidence of axial symptoms of patients in two groups during the follow-up period(P<0.05). Conclusion: Compare with anterior cervical decompression and fusion with bone graft, the long-term effect of Bryan cervical disc prosthesis replacement for patients with cervical spondylotic myelopathy is better, it can better improve the biomechanics of the cervical vertebra and reduce the incidence of axial symptoms in the neck, which is worthy of clinical application.