颈椎间盘突出症合并轻微骨化对间盘置换术后置换节段活动度的影响

Impact of cervical disc herniation combined with mild ossification on range of motion after cervical artificial disc replacement

目的观察颈椎间盘突出症合并轻微骨化患者人工间盘置换术后置换节段活动度保持情况,明确其是否可作为颈椎人工间盘置换术的适应证。方法选择因颈椎间盘突出症行单节段人工间盘置换术患者54例,术前CT检查合并椎体后缘或者间盘轻微骨化42例(A组),单纯颈椎间盘突出症12例(B组)。比较各组性别、年龄及随访时间,术前及末次随访时应用动力位X线片观察置换节段的活动度,末次随访时行CT检查判断手术节段是否发展为典型的颈椎后纵韧带骨化(OPLL)。结果 A组年龄大于B组,P<0.05;两组性别构成比、随访时间、术前及末次随访置换节段活动度两组比较无统计学差异,P均>0.05。A组有2例在随访81及96个月时发展为典型的节段型OPLL,但是置换节段活动度均有保留,分别为6.2°及15.4°;5例末次随访置换节段活动度<2°,其中4例由于适应证选择不当、1例在钩椎关节发生融合。结论颈椎间盘突出症合并轻微骨化不影响人工间盘置换术后置换节段活动度,可作为颈椎人工间盘置换术的适应证。

Objective To evaluate the impact of cervical disc herniation( CDH) combined with mild ossification on the long term range of motion( ROM) after artificial disc replacement( ADR) in CDH patients,and to find out whether it is an indication for cervical ADR. Methods Fifty-four patients who got ADR with the diagnosis of CDH were included. According to the preoperative CT,patients were divided into two groups,CDH with mild ossification( group A,42 cases) or simple CDH( group B,12 cases). ROM was compared between two groups by X-ray at preoperation and last follow-up. At last follow-up,axial and sagittal CT was used to identify whether fusion was occurred at the ADR level and whether the mild ossification turned into typical ossification of posterior longitudinal ligament( OPLL). Results The patients of group A were older than those of group B( P < 0. 05). There were no statistical differences in gender ratio,duration of follow-up,the ROM before operation and at last follow-up between the two groups( all P > 0. 05). In group A,2 patients turned into typical OPLL at the 81- and 96-month follow-up. But the ROM at ADR level of those two patients were maintained which were 6. 2° and15. 4°. There were 5 patients whose ROM at ADR level was less the 2° during the follow-up of group A,4 of them were due to the incorrect indication and the other patient did not have OPLL because the fusion occurred at uncovertebral joint.Conclusion The CDH combined with mild ossification doesn’t affect the ROM at ADR level,so it is an indication for ADR.