颈椎人工间盘置换术治疗单节段颈椎邻椎病的疗效观察

Clinical observation of single-segment cervical adjacent segment disease treated with artificial cervical disc replacement

目的探讨颈椎人工间盘置换术(ACDR)在治疗颈椎邻椎病的临床疗效及影像学结果。方法回顾性分析2013年12月至2016年7月在西安红会医院接受ACDR治疗的28例单节段颈椎邻椎病患者的临床资料;患者男19例,女9例,年龄(46±7)岁。对术前及术后1、24个月的临床疗效及影像学指标进行比较观察。临床疗效主要包括日本骨科协会评分(JOA),颈椎功能障碍指数(NDI%),Odom评分及手术相关并发症。影像学评估主要包括颈椎整体及手术节段活动度(ROM),手术节段Cobb角,邻近椎间盘退变程度,手术节段异位骨化,假体相关影像参数。结果患者术前、术后1个月和术后24个月JOA评分分别为(12.7±1.5)、(14.0±1.0)和(15.8±0.9)分,JOA改善率为75%±19%(F=37.012,P<0.01)。患者手术前后NDI%逐渐下降,治疗前后差异有统计学意义(F=159.101,P<0.01)。末次随访时Odom评分为优者20例,良8例。患者手术前后3个时间点颈椎整体和手术节段ROM、手术节段Cobb角差异均有统计学意义(F=4.633、6.063、26.952,均P<0.05)。术后24个月ACDR上方邻近椎间盘与融合节段下方邻近椎间盘的Miyazaki分级差异有统计学意义(μc=2.12,P=0.034)。术后4例(14.3%)发生手术节段异位骨化。假体冠状面移位(0.30±0.11)mm,矢状面(0.28±0.10)mm;假体下沉(0.27±0.09)mm。未见假体松动发生。结论ACDR对颈椎邻椎病翻修临床疗效满意。由于术后手术节段仍存在一定的运动功能,其邻近节段椎间盘退变的风险明显低于颈椎前路减压融合术。

Objective To investigate the clinical outcomes and radiographic results of artificial cervical disc replacement(ACDR)for cervical adjacent segment disease(ASD).Methods The clinical data of 28 patients with single-segment cervical ASD treated with ACDR in Xi′an Honghui Hospital from December 2013 to July 2016 were retrospectively analyzed.There were 19 males and 9 females with a mean age of(46±7)years(36-63 years).Preoperative,postoperative 1 month and postoperative 24 months of clinical and radiographic outcomes were recorded and compared.The clinical outcome mainly includes Japanese orthopedic association(JOA),Neck Disability Index(NDI%),Odom score and complications.Imaging assessment mainly included range of motion(ROM)of cervical spine,surgical segment ROM,Cobb angle of surgical segment,degree of adjacent disc degeneration,heterotopic ossification,and prosthesis related image parameters.Results In terms of clinical outcome,the average JOA score was 12.7±1.5 before surgery,14.0±1.0 one month after surgery,15.8±0.924 months after surgery,and the improvement rate of JOA was 75%±19%.The mean NDI%was 27.0%±2.8%before surgery,20.5%±1.6%one month after surgery,and 15.3%±2.8%24 months after surgery;the difference before and after treatment was statistically significant(F=159.101,P<0.01).Twenty patients were classified with excellent Odom score and 8 patients with good Odom score at the final follow-up.The total ROM of cervical spine,operation segment ROM,operation segment Cobb angle were all improved significantly after the operation(F=4.633,6.063,26.952,all P<0.05).There was a statistical difference in Miyazaki classification between adjacent discs above ACDR and below the fusion segment 24 months after surgery(μc=2.12,P=0.034).The incidence of heterotopic ossification was 14.3%.The results of displacement degree of prosthesis were as follow:coronal plane(0.30±0.11)mm,sagittal plane(0.28±0.10)mm;subsidence of the prosthesis:(0.27±0.09)mm.No prosthesis loosening was observed.Conclusions The clinical outcome of revision of cervical ASD by ACDR is satisfactory.The risk of intervertebral disc degeneration in adjacent segments is significantly lower than that of ACDF due to the presence of certain motor function postoperatively.