Prestige人工颈椎间盘置换术后异位骨化对颈椎活动度的影响

Effect of heterotopic ossification on cervical motion following Prestige artificial cervical disc replacement

目的分析Prestige人工颈椎间盘置换术后异位骨化(HO)对颈椎置换节段活动度(ROM)的影响,探讨导致人工颈椎间盘置换术后异位骨化形成的相关因素。方法回顾性分析重庆医科大学附属第一医院骨科2014年1月~2018年1月受Prestige人工颈椎间盘置换术的66例患者。在颈椎X线片上分析评估,测量置换节段活动度,并使用McAfee分级对异位骨化进行分级,采用Wilcoxon符号秩和检验分析异位骨化形成和与置换节段活动度间的关系,采用t检验分析异位骨化分级和对置换节段活动度间的影响。使用Logistic回归分析评估年龄、性别、身体质量指数(BMI),置换节段数量,术前项韧带骨化情况,病变椎间隙高度与相邻椎间隙高度比值、置换节段术前及术后活动度及围手术期非甾体类抗炎药(NSAIDs)的使用情况等因素与颈椎间盘置换术后异位骨化形成的关系。结果66例患者中23例患者末次随访时出现异位骨化,发生率为34.8%。异位骨化组置换节段活动度明显小于无异位骨化组,两者比较差异有统计学意义(P<0.05),McAfeeⅢ~Ⅳ级置换节段活动度明显小于McAfeeⅠ~Ⅱ级组,两者比较差异有统计学意义(P<0.01)。相关性分析结果显示,置换节段术前活动度及术后活动度与术后异位骨化具有相关性(P<0.05)。进一步选择置换节段术后活动度因素进行ROC曲线分析,置换节段术后活动度≤8°更容易发生异位骨化。结论Prestige人工颈椎间盘置换术后,异位骨化会导致置换节段活动度的减少,异位骨化分级越高置换节段活动度减少越明显。人工颈椎间盘置换术后异位骨化形成的发生与置换节段术前及术后活动度有关,术后置换节段活动度≤8°更容易发生异位骨化。

Objective To analyze the effect of heterotopic ossification(HO)on the postoperative segmental range of motion(ROM)after Prestige artificial cervical disc replacement,and to explore the related factors leading to the formation of heterotopic ossification after artificial cervical disc replacement.Methods We recruited of 66 patients who had Prestige artificial cervical disc replacement from January 2014 to January 2018 in Department of Orthopedics,the First Affiliated Hospital of Chongqing Medical University were retrospectively reviewed.To evaluate cervical spine X-ray,the replacement segment ROM was measured in picture,and the occurrence of HO was defined by the McAfee’s classification.The Wilcoxon signed rank test was used to analyze the relationship between heterotopic ossification formation and replacement segment ROM,the t test was used to analyze the influence between heterotopic ossification grading and replacement segment ROM.Nine clinical factors including age,gender,body mass index(BMI),number of replacement segments,preoperative ligament ossification,the preoperative disc height ratio of the target level and its adjacent level,preoperative mobility of replacement segments,postoperative mobility of replacement segments,whether to use nonsteroidal autiinflammatory drugs(NSAIDs)during perioperative period.The correlation between these nine clinical factors and the occurrence of postoperative HO was evaluated with logistic regression analysis.Results The occurrence rate of HO was 34.8%in last follow-up.The replacement segmental ROM of the heterotopic ossification group was significantly smaller than that of the non-ectopic ossification group,and the difference was statistically significant(P<0.05),and the McAfee gradeⅢ-Ⅳgroup was significantly less than the McAfee gradeⅠ-Ⅱgroup,and the difference was statistically significant(P<0.05).Correlation analysis showed that preoperative and postoperative ROM of the replacement segment presented statistical correlation(P<0.05).Furthermore analysis of ROC curve showed that heterotopic ossification was more likely to occur when the degree of ROM of the replacement segment≤8°.Conclusion HO after Prestige artificial cervical disc replacement reduces the replacement segmental ROM,especially for the McAfee gradeⅢ-Ⅳgroup.The occurrence of heterotopic ossification after Prestige artificial cervical disc replacement is related to the preoperative and postoperative mobility of the replacement segment.The ROM≤8°of the postoperative replacement segment is more likely to occur heterotopic ossification.