中国修复重建外科杂志

中国修复重建外科杂志

人工颈椎间盘置换术治疗神经根型颈椎病远期疗效观察

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目的探讨人工颈椎间盘置换术(cervical artificial disc replacement,CADR)治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的远期疗效及影响因素。方法回顾分析 2003 年 12 月—2007 年 12 月行 Bryan 假体 CADR 治疗的 29 例 CSR 患者 10 年以上随访资料。其中男 16 例,女 13 例;年龄 40~70 岁,平均 54.1 岁。病程 2~144 个月,平均 19.2 个月。病变节段:C3、4 2 例,C4、5 6 例,C5、6 18 例,C6、7 3 例。依据术前压迫因素将患者分为两组:单纯颈椎间盘突出组 14 例(A 组)及合并骨赘增生组 15 例(B 组)。两组患者性别、年龄、病程、病变节段等一般资料比较差异无统计学意义(P>0.05),具有可比性。分别于术前及末次随访时评估患者影像学和临床功能指标,影像学指标包括颈椎整体活动度(range of motion,ROM)、手术节段 ROM 及末次随访时 ROM 丢失(ROM<3°)发生率、手术节段 Cobb 角及局部后凸发生率、椎旁骨化(paravertebral ossification,PO)分级;临床功能指标包括颈椎功能障碍指数(NDI)和整体疗效评估(采用 Odom 标准)。结果患者均获随访,随访时间 121~153 个月,平均 130 个月。影像学评估结果示,组内比较:除末次随访时两组手术节段 Cobb 角较术前显著降低(P<0.05)外,颈椎整体 ROM、手术节段 ROM 手术前后比较差异均无统计学意义(P>0.05)。组间比较:除 B 组末次随访时 ROM 丢失发生率、高等级 PO 发生率显著高于 A 组(P<0.05)外,其余各指标两组间比较差异均无统计学意义(P>0.05)。临床功能评估结果示,A、B 组末次随访时 NDI 均较术前显著改善(P<0.05)。A、B 组手术前后 NDI、末次随访时 NDI 降低率及 Odom 评分比较,差异均无统计学意义(P>0.05);两组整体疗效优良率均达 100%。结论CADR 治疗 CSR 可获得满意的远期疗效,且单纯椎间盘突出患者术后远期手术节段 ROM 的保留程度优于合并骨赘增生患者。

ObjectiveTo evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR).MethodsThe data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C3, 4 in 2 cases, C4, 5 in 6 cases, C5, 6 in 18 cases, C6, 7 in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups (P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification (PO) grading. The clinical evaluation indexes included neck disability index (NDI) and overall efficacy (Odom’s score).ResultsAll patients were followed up 121-153 months (mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased (P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up (P>0.05). Except that the loss of ROM (ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A (P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups (P>0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups (P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom’s score between 2 groups (P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups.ConclusionCADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.

关键词: 人工颈椎间盘置换术; 神经根型颈椎病; 远期随访

Key words: Cervical artificial disc replacement; cervical spondylotic radiculopathy; long-term follow-up

引用本文: 宋卿鹏, 田伟, 何达, 韩骁, 张宁, 王晋超, 李祖昌. 人工颈椎间盘置换术治疗神经根型颈椎病远期疗效观察. 中国修复重建外科杂志, 2018, 32(6): 668-672. doi: 10.7507/1002-1892.201712045 复制

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