Hybrid术中融合对邻近置换节段的影响

Effect of the Fused Level on Adjacent Disc Prosthesis in Hybridsurgery

目的研究与单节段颈椎间盘置换(cervical disc replacement,CDR)相比,Hybrid手术中融合对邻近人工间盘动力学及并发症的影响。方法回顾分析2012年3月至2015年9月在本院接受单节段CDR或单节段CDR+融合的Hybrid手术治疗,并完成至少4年随访的68例患者资料。单节段CDR组42例,男16例,女26例;年龄27~63岁,平均(43.69±7.27)岁。Hybrid组26例,男11例,女15例;年龄35~57岁,平均(47.04±6.26)岁。分别于术前和术后各随访时间点评估患者影像学和临床功能指标,包括置换节段曲度和其变化、置换节段及其邻近节段活动度(range of motion,ROM)、假体前后移位和下沉、异位骨化、置换节段的相邻节段退变以及临床功能评分。比较两组间相关评估指标的差异及组内相关指标手术前后的差异。结果尽管两组在末次随访时均能维持置换节段术前的局部曲度(P>0.05),但与单节段CDR组相比,Hybrid组术后即刻增加的节段前凸在末次随访时更易丢失(P<0.05);Hybrid组并没有呈现出间盘假体的高活动度,也能在末次随访时维持假体邻近节段的术前ROM(P>0.05);Hybrid组假体平均下沉和前后移位的量更大,特别是移位方面差异有统计学意义(P<0.05),但是两组间在明显下沉和移位的病例数量上差异无统计学意义(P>0.05);Hybrid组异位骨化和邻近节段退变的发生率较高,但差异无统计学意义(P>0.05)。两组在术后临床功能评分上均较术前明显改善(P<0.05),但两组间比较差异无统计学意义(P>0.05)。结论与单节段CDR相比,尽管Hybrid术中融合节段影响了其相邻人工椎间盘的部分动力学表现,但并没有明显增加假体并发症和引起不良临床效果。

Objective To study the effect of the fused level on the prosthetic dynamics and complications in hybrid surgery compared with single-levelcervical disc replacement(CDR).Methods Between March 2012 and September 2015,patients undergoing either a 1-level CDR or hybrid surgery(1-level CDR+fusion)wereretrospectively reviewed.All patients were followed up clinically and radiographically for a minimum of 4 years.The patients in the 1-level CDR group included 16 men and 26 women,with a mean age of(43.69±7.27)years(27~63).The patients in the hybrid group included 11 men and 15 women,with a mean age of(47.04±6.26)years(35~57).Radiologicalparameters and clinical outcome scores were evaluated at preoperative and postoperative follow-up points,includingsegmental alignmentand its changes,range of motion(ROM)of the disc replacement and its adjacent segments,migration and subsidence of the prosthesis,heterotopic ossification(HO),adjacent segment degeneration(ASD)adjacent to the arthroplasty level,andclinical outcome scores.Results Compared to the 1-level CDR group,the increased segmental lordosis immediately after surgery in the hybridgroup was more likely to be lost throughout the follow-up period(P<0.05),although both groups generally maintainedthe preoperative segmental alignment of the arthroplasty segment postoperatively(P>0.05);thehybridgroup did not exhibithypermobility of the disc prosthesis and preserved the preoperative ROM of theadjacent segment of the device(P>0.05);The mean amount of subsidence and migrationof the prosthesis in the hybridgroup was relatively larger,especially the difference in prosthesis migration was significant(P<0.05),but there was no significant difference in the number of cases of obvious migration or subsidence between the groups(P>0.05);the incidence rates of HO and ASD in the hybridgroup were higher,but there were no significant differences(P>0.05).The clinical outcome scores of the two groups at the final follow-up were significantly improved compared with that of preoperative(P<0.05),and there were no significant differences between two groups(P>0.05).Conclusion Although the fused level in the hybridgroup partially affected the dynamicperformance compared to single-level CDR,it did not increase prosthesis-related complications and causeadverse clinical outcomes.