Bryan颈椎人工椎间盘置换术后再手术原因及疗效分析

Analysis of causes and effects of reoperation after Bryan cervical total disc replacement

目的探讨Bryan颈椎人工椎间盘置换术(CTDR)后再手术原因及疗效。方法选择2003年12月—2008年12月在北京大学第三医院行Bryan CTDR且随访期内接受再手术治疗的6例患者为研究组,采用巢式病例对照研究法,选取30例年龄及性别相匹配、在同一时间段接受Bryan CTDR且随访期内未再行颈椎手术治疗的患者作为对照组。比较2组患者初次术前影像学特征,评估研究组的再手术治疗效果。结果研究组初次术前颈椎X线片退行性变评分高于对照组,发育性椎管狭窄发生率高于对照组,差异均有统计学意义(P<0.05)。研究组再手术治疗后,改良日本骨科学会(mJOA)评分较再手术前改善,差异有统计学意义(P<0.05);颈椎功能障碍指数(NDI)及疼痛视觉模拟量表(VAS)评分较术前虽有改善,但差异无统计学意义(P>0.05)。结论接受Bryan CTDR治疗的患者,如果术前颈椎退行性变程度较重,合并发育性颈椎椎管狭窄,则术后因复发性颈椎病而接受再手术治疗的风险较高。针对复发原因采取恰当的术式治疗能够显著改善患者神经功能障碍。

Objective To investigate the causes and effects of reoperation after Bryan cervical total disc replacement(CTDR). Methods A total of 6 patients who underwent Bryan CTDR in Peking University Third Hospital from December 2003 to December 2008 and underwent reoperation during the follow-up period were selected as the study group. Using the nested case-control study method,30 patients matched in age and sex who received Bryan CTDR at the same time and did not receive reoperation during the follow-up period were served as the control group. The preoperative radiographic characteristics of the 2 groups were compared,and the post-reoperative outcomes of the study group were evaluated. Results Before the initial operation,the roentgenographic degeneration score of the study group was higher than that of the control group,and the incidence rate of developmental spinal stenosis was higher than that of the control group,all with a statistical significance(P < 0.05). After reoperation,the score of modified Japanese Orthopaedic Association(mJOA) score in the study group was improved compared with that before reoperation,and the difference was statistically significant(P < 0.05);although the neck disability index(NDI) and pain visual analogue scale(VAS) score were improved,but the differences were not statistically significant(P > 0.05). Conclusions Patients treated with Bryan CTDR have a higher risk of reoperation due to recurrent cervical spondylosis if the degree of cervical degeneration before operation is severe and complicated with developmental cervical spinal stenosis. Appropriate surgical treatment for the causes of recurrence can significantly improve the neurological dysfunction of patients.