人工颈椎间盘置换术后椎体前缘骨吸收对疗效的影响及风险因素

Effect of anterior vertebral bone resorption after artificial cervical disc replacement and its risk factors

目的探讨颈椎病患者行人工颈椎间盘置换(artificial cervical disc replacement,ACDR)术后椎体前缘骨吸收(anterior vertebral bone resorption,AVBR)情况及风险因素,以及AVBR对手术疗效的影响。方法回顾性分析本院骨科于2015年3月~2019年3月开展ACDR手术的128例颈椎病患者资料,对其人口学资料、临床资料、手术资料、影像学资料、手术疗效和假体相关并发症等资料进行统计分析,采用组间单因素分析(AVBR组vs无AVBR组)和多因素Logistic回归分析筛选术后AVBR的风险因素。结果128例患者均成功完成ACDR手术,术后获访17~41个月,平均(27.3±9.2)个月。随访期间发生AVBR 68例,发生率53.1%,其中49例(72.1%)发生于术后3个月内。①与术前相比,两组患者术后3个月和末次随访的VAS、NDI和JOA评分均显著改善(P<0.05),但组间差异均无统计学意义(P>0.05)。②术后即刻,AVBR组患者的节段曲度显著大于无AVBR组(P<0.05),但两组术前和末次随访时无显著差异(P>0.05);末次随访时,AVBR组患者的上、下终板长度均显著短于无AVBR组患者(P<0.05),节段ROM显著大于无AVBR组(P<0.05)。③单因素分析显示,两组患者的年龄、BMI和术中出血量差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄(OR=0.836)、BMI(OR=0.854)均是患者术后发生AVBR的独立影响因素。④两组术后的假体相关并发症比较,差异无显著性(P>0.05)。结论AVBR现象在颈椎ACDR术后3个月内较为常见,但对手术疗效无明显影响。年龄偏小、BMI偏低者,是ACDR术后出现AVBR的高风险人群。

Objective To investigate the incidence and risk factors of anterior vertebral bone resorption(AVBR)in patients with cervical spondylosis after artificial cervical disc replacement(ACDR),and the effect of AVBR on the surgical effect.Methods The clinical data of 128 patients with cervical spondylosis who underwent ACDR from March 2015 to March 2019 were analyzed retrospectively.The demographic data,clinical data,surgical data,imaging data,surgical efficacy and prosthesis related complications were statistically analyzed.The risk factors of postoperative AVBR were screened by inter group univariate analysis(AVBR group vs non-AVBR group)and multivariate logistic regression analysis.Results All 128 patients successfully completed ACDR.They were followed up for 17~41 months,with an average of(27.3±9.2)months.During the follow-up period,68 cases occurred AVBR,with an incidence rate of 53.1%,of which 49 cases(72.1%)occurred within 3 months after operation.①Compared with before operation,the VAS,NDI and JOA scores of the two groups at 3 months after operation and the last follow-up were significantly improved(P<0.05),but there were no significant differences between the two groups(P>0.05).②Immediately after operation,the segmental curvature of patients in AVBR group was significantly higher than that in non-AVBR group(P<0.05),but there was no significant difference before operation and at the last follow-up(P>0.05).At the last follow-up,the length of upper and lower endplates in AVBR group was significantly shorter than that in non-AVBR group(P<0.05),and the segmental ROM was significantly greater than that in non-AVBR group(P<0.05).③Univariate analysis showed that there were significant differences in age,BMI and intraoperative bleeding between the two groups(P<0.05).Multivariate logistic regression analysis showed that age(OR=0.836)and BMI(OR=0.854)were independent influencing factors of postoperative AVBR.④There was no significant difference in prosthesis related complications between the two groups(P>0.05).Conclusion AVBR is common within 3 months after cervical ACDR,but it has no significant effect on the surgical effect.Those with younger age and lower BMI have high-risk of postoperative AVBR.