颈椎下终板形态对Prestige LP人工颈椎间盘置换术疗效的影响

Effect of inferior endplate morphology on clinical and radiological outcomes of single-level cervical disc replacement with Prestige-LP Disc

[目的]探究颈椎下终板形态对Prestige LP人工椎间盘置换术疗效的影响。[方法]回顾性分析2009年6月~2014年8月在本院接受C5/6单节段Prestige LP人工椎间盘置换术118例患者的临床资料。根据术前影像穹隆顶点位置将患者分为三组,Ⅰ型23例,穹隆顶点位置靠前;Ⅱ型66例,穹隆顶点位置居中;Ⅲ型29例,穹隆顶点位置靠后。比较三组间围手术期、临床和影像资料。[结果]三组患者均顺利完成手术,术中无血管、神经损伤。三组患者在手术时间、切口长度、术中出血量、术中透视次数和术后引流量的差异均无统计学意义(P>0.05)。三组患者随访18~63个月,平均(38.48±9.47)个月。随时间推移,三组患者的VAS评分和NDI评分均显著减少,而JOA评分显著增加。相同时间点,三组间VAS、JOA和NDI评分的差异均无统计学意义(P>0.05)。影像方面,末次随访时,Ⅰ型(34.78%,8/23)终板C5/6后凸发生率显著高于Ⅱ型(15.15%,10/66)和Ⅲ型(6.89%,2/29),差异有统计学意义(P<0.05)[结论]三种终板类型患者在Prestige LP人工颈椎间盘置换术后均能取得良好的临床效果。但是,Ⅰ型终板患者术后后凸发生率的风险高。

[Objective] To investigate the effects of inferior endplates geometry on clinical and radiological outcomes of single-level cervical disc replacement(CDR) with Prestige-LP Disc. [Methods] A retrospective study was conducted on 118 patients who received C5/6 CDR with Prestige-LP Disc from June 2009 to August 2014 in our hospital. Based on position of dome top of the inferior endplate measured on preoperative images, the patients were divided into 3 groups, including 23 patients with type Ⅰ inferior endplate that the dome top located posteriorly, 66 patients with type Ⅱ that the top was in the middle and 29 patients with type Ⅲ that the top placed anteriorly. The perioperative, follow-up and radiographic data were compared among the3 groups. [Results] All the patients had CDR on the C5/6 level performed smoothly without iatrogenic neurovascular injuries.There were no statistically significant differences among the 3 groups regarding operation time, incision length, intraoperative blood loss and frequency of X-ray(P>0.05). As time went during the follow-up period lasted for 18 to 63 months with a mean of(38.48±9.47) months, the VAS and NDI scores significantly decreased, whereas the JOA score significantly increased in all the 3 groups(P<0.05), although no a statistical difference was proved in any score at any matching time point among the 3 groups(P>0.05). With respect to radiographic assessment, the occurrence of C5/6 kyphosis was of 34.78%(8/23) in the type Ⅰ,15.15%(10/66) in the type Ⅱ and 6.89%(2/29) in the type Ⅲ at the last follow-up, which was of statistical significance(P>0.05). [Conclusion] The patients with all the three types of inferior endplatesdo achieve satisfactory clinical outcomes of single-level CDR, however, those with the type Ⅰ are at higher risk of local kyphosis after operation.