单节段人工颈椎间盘置换术后小关节退变的长期临床研究

【摘要】 目的：分析人工颈椎间盘置换（artificial cervical disc replacement，ACDR）术后颈椎小关节退变的危险因素，评价其对颈椎节段运动和临床疗效的影响。方法：回顾性分析我科2003年1月~2008年1月行单节段Bryan人工颈椎间盘ACDR术的颈椎退行性疾病患者70例，其中男性43例，女性27例；术后随访时间129±14（105~165）个月；年龄55.7±8.4（37~76）岁。术前、术后及末次随访时通过颈椎动力位X线片测量手术节段活动度和颈椎整体活动度；术前、末次随访时通过CT影像根据颈椎小关节定量评分系统评估颈椎小关节退变程度。术前及末次随访同时进行日本骨科协会（Japanese Orthopaedic Association，JOA）评分及颈椎功能障碍指数量表（neck disability index，NDI）评估患者临床症状，在末次随访时进行Odom标准评价分级和颈痛的视觉模拟评分（visual analogue scale，VAS）。结果：术前小关节无或轻度退变患者41例，中度退变患者28例，重度退变患者1例；末次随访时，小关节轻度退变患者16例，中度患者退变35例，重度关节退变患者19例。通过斯皮尔曼双变量相关性检验发现小关节退变与性别、年龄有相关性。高龄、男性是小关节退变增加的危险因素，手术节段与小关节退变程度无相关性。患者术前和末次随访时手术节段活动度不存在统计学差异（9.7°±4.5° vs 8.7°±5.4°，P>0.05），术前和末次随访时颈椎整体活动度不存在统计学差异（46.5°±15.2° vs 46.1°±13.0°，P>0.05）。患者术前及末次随访时小关节退变评分具有统计学差异（1.5±0.8分 vs 2.6±1.2分，P<0.05）；术前与末次随访时JOA评分具有统计学差异（13.5±1.9分 vs 16.5±1.4分，P<0.05）；术前与末次随访时NDI存在统计学差异（0.27±0.08 vs 0.16±0.10，P<0.05）。末次随访时Odom分级为优秀的有35例患者，为良好的有29例，为尚可的有6例，没有分级为差的患者，末次随访时VAS评分为3.47±1.55分。ACDR术后末次随访小关节退变程度与手术节段活动度呈负相关（r=-0.392，P=0.001），与整体活动度也呈负相关（r=-0.388，P=0.001），与JOA评分、NDI、Odom分级、VAS评分无显著性相关（P>0.05）。结论：高龄和男性是ACDR术后小关节退变的危险因素，小关节的退变程度与患者术后的颈椎活动度存在负相关，小关节退变程度与临床症状的缓解程度无关。     

Bryan颈椎人工椎间盘置换术后长期疗效随访研究

目的：观察评估Bryan颈椎人工椎间盘置换术后长期疗效。 方法：本研究评估我院Bryan颈人工椎间盘置换术后患者长期临床疗效及影像学结果,采用mJOA、VAS、及NDI分别评价术前、术后1周、术后2年及末次随访临床效果并进行比较,末次随访时Odom’s分级评估临床疗效;X线侧位片及颈椎过屈过伸位片上采用Cobb法评估术前术后颈椎曲度、颈椎ROM,MRI T2加权相上根据Miyazaki分级标准评估Bryan人工椎间盘置换术后邻近节段退变,X线及CT上根据McAfee评估标准评价异位骨化（HO）发生情况。 结果：本研究共纳入患者20例,男性15例,女性5例,平均年龄43.85±3.70岁,平均随访时长88.5±16.29月,其中单节段9例,双节段11例,C3/4 2例、C4/5 9例、C5/6 15例、C6/7 5例;（1）mJOA、VAS、NDI评分术后较术前均明显改善,末次随访时Odom’s标准评级优（8例）,良（8例）,可（2例）,差（2例）;（2）FSU Cobb角、C2-7 Cobb角术前分别为2.33±4.08°、18.78±6.68°,末次随访为3.21±6.56°、15.61±6.73°,两者之间均无统计学差异（p=0.405,p=0.082）;FSU ROM术前为8.94±3.19°,术后早期及末次随访分别为9.47±3.81°、9.34±4.13°,术前术后比较均无统计学差异（p>0.05）,而C2-C7 ROM、上下邻近节段ROM术后均下降（p<0.05）;HO发生率为74.2%,其中严重HO（Ⅲ级或Ⅳ级）发生率为22.6%;末次随访时ASD发生率为46.5%,无症状性ASD发生。 结论：Bryan颈人工椎间盘置换术治疗颈椎退变性疾病可以取得持久稳定的临床效果,尽管异位骨化发生率较高,但大部分保留手术节段活动,同时邻近节段仍可见退变,但均无临床症状。     

人工颈椎间盘置换术与前路植骨融合内固定术治疗颈椎退行性疾病的疗效比较

目的对比分析人工颈椎间盘置换术(ACDR)与颈椎前路植骨融合内固定术(ACDF)治疗颈椎退行性疾病患者的临床效果及对颈椎运动功能、邻近节段退变的影响。方法回顾性收集152例颈椎退行性疾病患者临床资料,根据选择手术方式不同分为ACDR组(n=53)和ACDF组(n=99);比较两组临床疗效以及对术后颈椎运动功能、邻近节段退变的影响。结果 ACDR组Odom分级优良率为84.91%,ACDF组为85.86%,组间差异无统计学意义(P0.05);末次随访时,两组VAS、NDI评分较术前明显降低(P0.05),JOA评分较术前明显升高(P0.05),且两组间差异无统计学意义(P0.05);末次随访时,ACDR组颈椎整体曲度、手术节段曲度、邻近节段曲度与术前比较差异无统计学意义(P0.05),而ACDF组颈椎整体活动度、手术节段活动度明显低于术前及ACDR组(P0.05),上、下邻近节段活动度明显高于术前及ACDR组(P0.05)。ACDR组ASDz发生率为13.21%,明显低于ACDF组的29.29%,差异有统计学意义(P0.05)。结论 ACDR与ACDF疗效相当,而前者有保留手术节段活动度、维持颈椎生物力学稳定的优势,能够有效减少邻近节段退变的发生。     

人工颈椎间盘置换术治疗颈椎病的中长期临床疗效

【摘要】 目的：回顾性分析人工颈椎间盘置换术（artificial cervical disc replacement，ACDR）治疗颈椎病的中长期临床疗效及并发症发生情况。方法：2009年5月～2015年5月在我科接受ACDR治疗的68例颈椎病患者纳入本研究。其中男性32例，女性36例；年龄39.1±6.2岁（23～55岁）。脊髓型颈椎病42例，神经根型颈椎病19例，混合型颈椎病7例。术前病程9.5~21.5个月（14.5±6.3个月）。52例接受单节段ACDR，16例接受两节段ACDR。人工椎间盘为Discover假体。采用日本矫形外科学会（Japan Orthopedic Association，JOA）评分法、疼痛视觉模拟评分法（visual analogue scale/score，VAS）和颈椎功能障碍指数（neck disability index，NDI）对患者的神经功能和临床症状情况进行评估；术前、术后及末次随访时采用颈椎X线片评估患者颈椎曲度（C2-C7 Cobb角），采用颈椎过屈过伸位X线片测量手术节段的活动度，在侧位X线片上观察手术节段的邻近节段骨赘形成情况，采用骨赘形成分级判断邻近节段的退变情况。末次随访时采用颈椎CT平扫+三维重建和McAfee分级法评估手术节段异位骨化（heterotopic ossification，HO）情况。记录患者术后轴性症状等并发症发生情况。结果：随访78~132个月（98.3±17.2个月），随访期间JOA评分、VAS评分和NDI均获得了良好改善，末次随访时与术前比较均有显著性差异（P＜0.05）。术后第二天，纳入患者的颈椎曲度与术前比较有统计学差异（12.5°±3.9° vs 9.3°±5.5°, P=0.044），末次随访时的颈椎曲度与术前比较无统计学差异（10.3°±4.2° vs 9.3°±5.5°，P=0.181）。手术节段的活动度术前为6.5°±3.4°，术后第2天为8.7°±2.8°（P=0.001），术后1年随访时为8.2°±3.8°，术后2年随访时为7.5°±4.1°，术后5年随访时为5.3°±4.8°，末次随访时为4.5°±2.7°，末次随访时与术前和术后1年时比较均明显降低（P=0.021，P=0.019）。末次随访时头侧和尾侧相邻节段骨赘形成分级分别加重0.46和0.41级。术后1年随访时轴性症状发生率为4.41%（单节段组2例、两节段组1例），术后5年以后随访无颈部疼痛等主诉。末次随访时有46例（67.65%）患者、51个（60.71%）手术节段发生不同程度的HO，两节段组患者HO的发生率明显高于单节段组患者（81.25% vs 63.46%，P=0.048）。结论：ACDR治疗颈椎病具有较好的中长期临床疗效，但伴随随访时间延长HO发生率趋于增加，且并未明显获得防止邻近节段退变的优势。     

颈椎前路Hybrid术式治疗相邻双节段颈椎病的中长期疗效分析

【摘要】 目的：观察颈椎前路Hybrid术式治疗相邻双节段颈椎病的中长期临床疗效、影像结果及Bryan人工颈椎间盘置换节段的在体运动功能状态。方法：回顾性分析2010年7月～2013年12月于我院行颈椎前路相邻双节段Hybrid手术的患者,置换节段采用Bryan人工颈椎间盘,融合节段采用MC+椎间融合器,纳入末次随访时置换节段活动度（range of motion,ROM）＞5°的43例患者,其中男性23例、女性20例,年龄49.1±5.6岁。脊髓型颈椎病26例,神经根型颈椎病6例,混合型颈椎病11例。术后随访84~119个月（95.43±8.21个月）,采用日本骨科协会（Japanese Orthopaedic Association,JOA）颈椎评分、颈椎功能障碍指数（neck disability index,NDI）、疼痛视觉模拟评分（visual analogue scale,VAS）及Odom分级评估临床疗效。收集术前与末次随访时的颈椎中立侧位和动力位X线片,对比术前与末次随访时的颈椎整体ROM及曲度（C2-C7）、手术节段曲度、置换节段屈伸旋转中心（flexion and extension-center of rotation,FE-COR）及ROM、手术相邻节段ROM;末次随访时,观察邻近节段退变（adjacent segment degeneration,ASD）发生情况、融合节段融合情况,测量置换节段平移距离与关节突关节解剖参数：上关节突高度（height of superior articular process,HSAP）、关节突关节间隙倾斜度（orientation of zygapophyseal joint spaces,OZJS）和上关节突关节面长度（length of superior articular surface,LSAS）,分析置换节段FE-COR与各项随访指标的相关性。结果：末次随访时,JOA评分较术前显著性升高（9.26±3.38 vs 15.21±1.42,P＜0.05）,改善率为（80.23±13.80）%,NDI、颈痛VAS评分及双上肢痛VAS评分均较术前显著性降低（34.12±8.96 vs 7.21±4.32,P＜0.05;5.77±2.28 vs 1.72±0.96,P＜0.05;5.26±2.67 vs 1.14±0.83,P＜0.05）,改善率分别为（80.03±10.52）%、（69.85±13.44）%和（78.84±15.89）%。Odom分级优24例、良12例、可7例,优良率为83.72%。颈椎整体曲度、手术节段曲度分别由术前的14.76°±8.04°、4.78°±5.86°增加至末次随访的20.62°±9.06°、6.75°±4.65°（P＜0.05）,颈椎整体ROM、置换节段FE-COR及ROM、手术相邻节段ROM与术前比较均无统计学差异（P＞0.05）。81个纳入研究的手术相邻节段（上位43个、下位38个）7个节段发生ASD（8.64%）,分属于7例患者（7/43,16.28%）,1例患者融合节段未获得骨性融合,但处于稳定状态（ROM＜2°）,其余患者融合节段均获得骨性融合,未发现与FE-COR横坐标（X）相关的随访指标（|r|＜0.5或P＞0.05）,FE-COR纵坐标（Y）与同节段ROM、平移距离呈负相关（r=-0.674,P＜0.05;r=-0.792,P＜0.05）,与HSAP呈正相关（r=0.754,P＜0.05）,与其他随访指标无显著相关性（|r|＜0.5或P＞0.05）。结论：颈椎前路相邻双节段Hybrid手术患者7年以上随访的临床与影像学结果满意,无证据显示融合节段对置换节段运动功能状态产生明显影响。     

人工颈椎间盘置换的近期临床疗效和影像学分析

目的分析人工颈椎间盘置换治疗神经根型颈椎病的临床疗效和影像学改变。方法回顾2012年9月至2014年3月收治的行单节段人工颈椎间盘置换术的神经根型颈椎病患者30例,其中获得完整随访资料的21例,于术前及术后7 d、1个月、3个月、6个月行临床评估和影像学数据采集。使用Odom评级、疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)评分及颈椎功能障碍指数(neck disability index,NDI)评分评估临床疗效及神经功能的改善情况,通过颈椎正侧位、动力位X线片观察颈椎整体、置换节段脊柱功能单位的曲度及活动度,以及置换节段相邻节段的活动度。结果 21例患者获得完整随访,随访时间6~9个月,平均6.8个月。NDI评分自术前(40±8.4)分下降到末次随访的(12±7.3)分(P0.05),JOA评分由术前(9±3.2)分提高到末次随访的(13.6±3.0)分(P0.05),上肢疼痛VAS评分由术前(7.6±1.6)分下降至末次随访(1.8±0.4)分(P0.05)。术后3个月颈椎曲度、置换功能节段曲度、颈椎活动度及置换功能节段的活动度较术前明显改善。术后3、6个月邻近节段活动度无明显改变。结论人工颈椎间盘假体行椎间盘置换术临床效果可靠,影像学资料显示术后可改善颈椎整体及置换节段曲度和活动度,保留临近节段活动度。     

连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期研究

【摘要】 目的：对连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期观察研究。方法：回顾性分析我科2004年1月~2011年12月行连续双节段人工颈椎间盘置换术的患者21例,其中男性15例,女性6例;年龄33~72岁,平均50.4±8.8岁。C3/4、C4/5间盘置换5例,C4/5、C5/6间盘置换14例,C5/6、C6/7间盘置换2例。随访时间96~156个月,平均随访116.5±19.6个月。记录患者术前、术后3个月及末次随访时改良日本骨科协会评分（modified Japanese Orthopaedic Association,mJOA）、视觉模拟评分法（visual analogue scale,VAS）评分,末次随访时在颈椎动力位X线片中测量人工颈椎间盘活动度,颈椎侧位X线片中测量颈椎曲度,采用McAfee分级法在颈椎侧位及动力位X线片上对人工颈椎间盘的异位骨化情况进行评估。结果：患者术前mJOA评分14.0±2.0分。术后3个月时mJOA评分15.2±1.8分,末次随访时mJOA评分16.8±1.2分,均较术前有统计学差异（P＜0.05）。术前VAS评分5.1±1.7分。术后3个月时VAS评分1.9±1.4分,末次随访时VAS评分0.9±0.8分,均较术前有统计学差异（P＜0.05）。术前颈椎曲度为平均16.7°±6.6°,末次随访时颈椎曲度为15.7°±7.3°,无统计学差异（P=0.25）。上位节段活动度为6.23°±10.13°,下位节段活动度为3.76°±4.81°,有统计学差异（P=0.025）。至末次随访时16例发生异位骨化,发生率为76.2%。根据McAfee分级,21例患者42个节段中,Ⅰ级5个节段,Ⅱ级5个节段,Ⅲ级14个节段,Ⅳ级7个节段,发生Ⅲ级以上HO的概率为50%,上位节段发生Ⅲ级和Ⅳ级HO的概率为38.0%,下位节段发生Ⅲ级和Ⅳ级HO的概率为61.9%。结论：长期随访发现行连续双节段Bryan人工颈椎间盘置换术后异位骨化发生率较高,且下位节段发生严重HO的概率明显增加。     

Bryan颈椎人工椎间盘置换术的长期疗效观察

目的 评估Bryan颈椎人工椎间盘置换术的长期疗效。方法 对2004年12月至2008年8月于我院行Bryan颈椎人工椎间盘置换术的20例病人进行回顾性分析,男15例,女5例,平均年龄为（43.85±3.70）岁,其中单节段9例,双节段11例,C_3/4 2例、C_4/5 9例、C_5/6 15例、C_6/7 5例。①收集并比较其术前、术后1周、术后2年及末次随访的改良日本骨科协会（modified Japanese Orthopaedic Association, mJOA）评估治疗分数、疼痛视觉模拟量表（visual analogue scale, VAS）评分、颈椎功能障碍指数（neck disability index, NDI）以及Odom''s分级。②通过其术前、术后早期及末次随访时的X线侧位片及颈椎过屈过伸位片,评估其颈椎曲度、颈椎活动度（ROM）。③MRI T2加权像上根据Miyazaki分级标准评估Bryan人工椎间盘置换术后邻近节段的退变情况。④通过X线片及CT片根据McAfee标准评价异位骨化的发生情况。结果 ①术前及末次随访时的mJOA评分分别为（13.30±2.83）分、（15.25±2.07）分,VAS评分分别为（4.10±3.81）分、（1.55±1.53）分,NDI分别为（11.45±9.52）分、（6.00±4.78）分,所有评价指标末次随访时较术前均有显著改善,差异均有统计学意义（P均＜0.05）。末次随访时Odom''s分级为优8例,良8例,可2例,差2例。②脊柱功能单位（FSU）曲度及C₂~C₇曲度：术前分别为2.33°±4.08°、18.78°±6.68°,术后早期为4.12°±6.43°、20.00°±9.98°,末次随访时分别为3.21°±6.56°、15.61°±6.73°。FSU ROM及C₂~C₇ ROM：术前分别为9.15°±2.80°、47.28°±9.75°,术后早期为9.27°±3.83°、40.81°±14.66°,末次随访分别为9.37°±3.97°、42.03°±10.97°。3个时间点的FSU曲度及FSU ROM比较,差异均无统计学意义（P均＞0.05）,但C₂~C_{7 ROM术后较术前明显减少,与邻近节段ROM变化趋势一致。末次随访时,43个邻近节段中46.5%发生邻近节段退变（adjacent segment degeneration, ASD）,以C5/6最为常见,但均无临床表现;末次随访时31个手术节段中有23例（74.2%）发生异位骨化,其中严重异位骨化（Ⅲ、Ⅳ级）发生率为22.6%,C5/6最为常见。结论 Bryan颈椎人工椎间盘置换术治疗颈椎退变性疾病可以取得持久稳定的临床效果,尽管异位骨化发生率较高,但大部分保留手术节段活动,同时邻近节段仍可见退变,但均无临床症状。}     

人工椎间盘置换术治疗跳跃型多节段颈椎病的中期疗效

 目的 评价 Bryan 人工间盘置换术治疗跳跃型多节段颈椎病的疗效。方法 回顾性分析 2002 年 2 月至 2012 年 5 月接受 Bryan 间盘置换术（Bryan 组）或颈前路减压植骨融合术（ACDF 组）治疗的跳跃型多节段颈椎病患者相关资料。临床功能评估采用日本矫形外科协会（Japanese orthopaedic association,JOA）评分、颈椎功能障碍指数（neck disability index,NDI）、疼痛视觉模拟评分（visual analoguc scale,VAS）,影像学评估采用颈椎矢状位曲度、颈椎整体活动度及中间节段活动度,并于末次随访时评估邻近节段退变情况。结果 49 例患者随访超过 24 个月,Bryan 组 18 例,ACDF 组 31 例。两组患者性别、年龄、疾病类型等人口学资料的差异无统计学意义。两组患者术后 JOA、NDI、VAS 评分均较术前有明显改善。两组间各时间节点比较仅末次随访时 VAS 评分的差异有统计学意义。Bryan 组术后轴性症状发生率、颈椎活动度和未手术节段活动度分别为 11.1%、35.5°±5.9°和 7.3°±1.4°,ACDF 组分别为 45.2%、24.5°±6.2°、10.1°±1.6°,差异均有统计学意义。Bryan 组患者邻近节段无明显退变,ACDF 组 2 例出现退变,但无需再次手术。结论 应用 Bryan 间盘置换术治疗跳跃型多节段颈椎病,可有效改善神经功能,保留颈椎整体活动度,减少未手术节段活动度的代偿性增加,从而降低邻近节段退变及轴性症状发生率。     

颈椎前路椎间融合术与人工椎间盘置换术联合椎间融合术治疗连续双节段颈椎病的中长期疗效对比

目的 :比较前路颈椎椎间融合术(anterior cervical discectomy and fusion,ACDF)与颈前路人工椎间盘置换联合颈椎椎间融合(Hybrid手术)治疗连续双节段颈椎病的中长期疗效。方法:回顾性分析2007年1月~2012年3月在我科行ACDF及Hybrid手术治疗的连续双节段颈椎病患者,资料完整且随访时间60个月者共68例,其中ACDF 39例(ACDF组),Hybrid手术29例(Hybrid组),两组患者年龄、性别构成比、随访时间、手术节段等均无统计学差异。比较两组术前及末次随访时的JOA评分、颈椎功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、颈椎整体活动度、C2-C7颈椎曲度、相邻节段活动度、相邻节段退变情况等。结果:两组患者手术时间、出血量和术后引流量均无统计学差异;末次随访时的JOA、NDI及VAS评分均较同组术前有显著性改善(P0.05),两组间同时间点比较均无统计学差异(P0.05)。末次随访时根据Odom标准,Hybrid组的优良率为93.1%,ACDF组为92.3%,两组比较无统计学差异(P0.05);两组C2-C7曲度较术前均有所恢复,Hybrid组较ACDF组改善更好(P0.05);Hybrid组整体颈椎活动度及相邻节段活动度较术前无明显差异(P0.05),ACDF组颈椎活动度较术前明显降低(P0.05)、相邻节段活动度明显增加(P0.05);颈椎X线片评估相邻节段退变发生率无统计学差异(Hybrid组17.2%vs ACDF组20.5%,P0.05);末次随访时Hybrid组人工间盘置换节段异位骨化发生率为34.5%(10/29),其中Mobi-C假体发生率为41.2%(5/12),Pro Disc-C假体发生率为29.4%(5/17)。结论 :Hybrid手术治疗双节段颈椎病5年以上随访临床疗效及安全有效性与ACDF相当,但Hybrid手术可以更好地重建颈椎曲度,减少邻近节段代偿性活动的同时保持颈椎活动度。     

Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study

BACKGROUND CONTEXTThe theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial.PURPOSEThe present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center.STUDY DESIGNThis was a propensity-score matched cohort study.PATIENT SAMPLEThis study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups.OUTCOME MEASURESThe outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications.METHODSNDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method.RESULTSThe average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%).CONCLUSIONSThrough nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.     

Discover人工颈椎间盘置换治疗颈椎病的初步应用

目的通过与颈前路减压植骨内固定术治疗患者比较,探讨应用Discover人工颈椎间盘置换治疗颈椎病的早期效果。方法回顾分析2010年3月-2011年3月24例符合选择标准的神经根型和脊髓型颈椎病患者临床资料,按收治时间分为颈前路减压融合组(融合组13例,2010年3月-2010年9月)和Discover人工颈椎间盘置换组(置换组11例,2010年9月-2011年3月)。两组患者性别、年龄、病程、病变分型、病变节段等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录手术时间、出血量、术后并发症,采用日本骨科协会(JOA)改善率、颈椎功能障碍指数(NDI)、Odom’s评分评价疗效;置换组于手术前后X线片上测量置换及其邻近节段的过伸过屈、左右侧屈活动度,以及假体偏心距。结果两组患者术后症状均缓解,未出现明显并发症。患者均获随访,融合组随访时间12～18个月,平均15.3个月;置换组随访时间6～12个月,平均9.6个月。术后1、3、6个月置换组NDI均高于融合组(P<0.05),但JOA评分改善率比较差异无统计学意义(P>0.05)。末次随访时融合组Odom’s评分为优6例,良4例,可3例,优良率76.92%;置换组为优9例,良1例,差1例,优良率90.91%;两组比较差异无统计学意义(χ2=3.000,P=0.223)。术后置换组过伸过屈及右侧屈活动度于1个月时明显减小(P<0.05),之后逐渐恢复;左侧屈活动度呈先增加后减少趋势,其中3、6个月时较术前明显增加(P<0.05)。术后置换节段和上位节段左侧屈活动度大于右侧屈(P<0.05),且上位节段左、右侧屈活动度差约为置换节段的2倍;侧屈活动度差与假体偏心距成正相关(P<0.05),且假体偏向侧的侧屈活动度增大,对侧活动度减小。结论 Discover人工颈椎间盘置换术是一种简便、安全且能保留颈椎活动的手术,早期疗效较好。     

人工椎间盘置换术治疗脊髓型颈椎病的临床疗效分析

目的探讨人工颈椎间盘置换术(CADR)与前路减压椎体融合术(ACDF)对比治疗单节段脊髓型颈椎病(CSM)的早中期临床疗效。方法 2015年1月至2018年1月,共完成随访单节段CSM患者40人,其中19人采用ACDF治疗,21人采用CADR治疗,两组患者分别观察记录术前、术后3个月、术后1年、术后3年的JOA评分与NDI评分,以及JOA评分改善率;检查MRI与X线影像变化,观察术后减压效果及内置物位置是否满意。结果两组患者术后的临床症状均得到明显缓解,神经功能得到显著改善,组内比较,术后各个时间段JOA评分、NDI评分与术前相比均有统计学差异(P0.05);组间比较,ACDF组与CADR组术后各时间段的JOA评分无明显差异(P0.05)、NDI评分CADR组术后各时间段均优于ACDF组(P0.05);ACDF组JOA评分优良率为84%,CADR组为90%,无明显统计学差异(P0.05)。影像学表现,末次随访ACDF组融合成功率为94.7%,CADR组2例发生轻度异位骨化,但人工椎间关节活动度无明显受限。两组均未发生严重的术后并发症。结论通过与经典前路融合术式的疗效对比,人工颈椎间盘置换术不仅能获得同样优良的减压效果,还能利用仿生假体维持原有的椎间活动能力,有效避免因融合导致的周围骨关节代偿功能增加而发生的退变,取得满意的近期疗效。     

3种前路手术治疗单节段脊髓型颈椎病的中期疗效比较

目的比较分析颈前路椎间盘切除融合术(ACDF)、颈前路椎体次全切除融合术(ACCF)和人工颈椎间盘置换术(CADR)治疗单节段脊髓型颈椎病的中期疗效。方法回顾性分析自2004-01—2012-01行ACDF、ACCF和CADR手术治疗的79例单节段脊髓型颈椎病。ACDF组44例,ACCF组22例,CADR组13例。比较3组手术时间、术中出血量,术后6、60个月VAS评分、JOA评分、NDI指数、SF-12评分及颈椎曲度。结果 79例均获得61~88(69.8±12.7)个月随访。ACDF组与ACCF组植骨融合时间差异无统计学意义(P0.05)。术后6个月时,ACCF组JOA评分均高于ACDF组及CADR组,ACDF组与ACCF组颈椎曲度优于CADR组,差异有统计学意义(P0.05);而3组VAS评分、NDI指数和SF-12评分比较差异无统计学意义(P0.05)。术后60个月时,ACDF组与CADR组VAS评分、NDI指数低于ACCF组,而SF-12评分高于ACCF组;ACDF组颈椎曲度优于ACCF组与CADR组,且CADR组优于ACCF组,差异有统计学意义(P0.05);而3组JOA评分差异无统计学意义(P0.05)。结论 ACCF在短期内神经功能恢复优于ACDF和CADR,但在随访中期ACCF在症状缓解、生活质量改善及颈椎曲度的维持方面却差于ACDF和CADR。     

Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages

The objective of this study is to evaluate the effect of anterior cervical discectomy and fusion (ACDF) on the motion of the cervical spine and dynamic stress (tendency to kyphosis) on adjacent segments and on the overall spinal alignment which may predispose to symptomatic disc diseases at other levels. Twenty consecutive patients underwent ACDF with a mean follow-up of 28 months (range 13-38). Preoperative and postoperative clinical assessments were done by using the neck disability index (NDI) and the Japanese Orthopedic Association (JOA) score. In all cases, at the last follow-up control, a neuro-radiographic assessment [cervical spine static and dynamic X-ray and magnetic resonance imaging (MRI)] was done. The angle of the operated disc space, the disc space angle of contiguous segments, and their range of motion (ROM) and the kyphotic Cobb angle (C2-7) were measured by computer software. The study was done at Sant'Andrea Hospital, Rome, Italy in the period from November 2003 to November 2005. We observed that: the mean Cobb angle improved significantly (p < 0.001) from 3.4 degrees (kyphosis) to postoperative 14.5 degrees . This normalization of angle showed a direct effect on improvement of myelopathic patients, but it had a statistically nonsignificant effect on adjacent segments degeneration (ASD). The mean segmental ROM of adjacent segments did not show significant instability. The mean was 11.1 degrees at upper and 10.2 degrees at lower levels (close to normal). In six cases, the ROM was higher than normal: five of these patients demonstrated symptomatic adjacent segment pathology. Postoperative improvement of mean JOA and NDI scores was statistically significant (p < 0.001). Anyway, symptomatic ASD was observed in five patients (20%): in four of them, the higher disc spaces and in one, the lower disc spaces were involved. In four cases, the preoperative MRI showed slight and asymptomatic disc degeneration at the same levels involved subsequently. This ASD was significantly related to the increased ROM at the segments involved. Follow-up X-rays showed solid fusion with absence of movement in all but one case (at 13-month follow-up), who showed slight movement in the operated level in spite of clinical improvement. The follow-up MRI showed, in all cases, good decompression in the treated levels. Compensatory increase in ROM of the contiguous motion segments in patients subjected to ACDF may lead to ASD especially in those cases with asymptomatic adjacent subclinical degenerative disease. If these preliminary results will be confirmed by larger series, it could be reasonable in young selected patients with soft disc herniation to adopt total disc arthroplasty instead of fusion after cervical micro-discectomy.     

A prospective,randomised, controlled multicentre study comparing cervical disc replacement with anterior cervical decompression and fusion

Purpose

Total cervical artificial disc replacement (TDR) simulates normal disc structure, thus avoiding the drawbacks of anterior cervical decompression and fusion (ACDF). This prospective, randomized, controlled and multicentre study aimed to evaluate clinical and radiographic outcomes by comparing cervical disc replacement using Mobi-C disc prostheses with ACDF.

Methods

This prospective, randomized, controlled and multicentre study consisted of 111 patients undergoing single-level Mobi-C disc prosthesis replacement (TDR group, n?=?55) or ACDF (n?=?56) from February 2008 to November 2009 at 11 medical centres across China. Patients were assessed before surgery, at seven days postoperation and one, three, six, 12, 24, 36 and 48 months postoperation. Clinical and neurological outcome was determined by measuring the Japanese Orthopaedic Association (JOA) scores, visual analogue scale (VAS) and Neck Disability Index (NDI). Static and dynamic radiographs were obtained of the cervical curvature, the functional spinal unit (FSU) angle and range of motion (ROM) of the cervical spine, FSU angle and treated and adjacent segments.

Results

A total of 111 patients were included and randomly assigned to either Mobi-C disc prosthesis replacement or ACDF. JOA, VAS and NDI showed statistically significant improvements 48 months after surgery (P?p?>?0.05). ROM in the ACDF group was significantly reduced at one month and remained so throughout the follow-up. By 48-months, more ACDF patients required secondary surgery (four of 56 patients).

Conclusions

Although ACDF may increase the risk of additional surgery, clinical outcomes indicated that both Mobi-C artificial cervical disc replacement and ACDF were reliable. Radiographic data showed that ROM of the cervical spine, FSU angle and treated and adjacent segments were relatively better reconstructed and maintained in the Mobi-C group compared with those in the ACDF group.     

颈人工椎间盘置换治疗单节段颈椎病的中期随访研究

目的观察颈人工椎间盘置换术(CTDR)治疗单节段颈椎病的中期临床疗效。方法回顾性分析2009年1月—2011年10月本院收治的随访4年的81例单节段退变性颈椎病患者临床资料,按照手术方式分为CTDR组(n=41)及颈椎前路椎间盘切除减压融合术(ACDF)组(n=40)。采用颈椎功能障碍指数(NDI)和日本骨科学会(JOA)评分进行功能评价,采用Mc Afee分级评定异位骨化情况,并进行组间比较。通过MRI进行影像学评估,比较2组手术节段、邻近节段活动度(ROM)和C_(2~7) Cobb角。结果两组患者术后NDI和JOA评分明显改善。术后1个月CTDR组NDI明显高于ACDF组,在工作、驾车和娱乐3个项目上差异均有统计学意义(P0.05),两组之间JOA评分改善差异无统计学意义(P0.05)。在上、下邻近节段ROM和C_(2~7) Cobb角方面,CTDR组术前、术后变化不明显;ACDF组上位邻近节段ROM术后明显增加,C_(2~7) Cobb角术后明显减小,与术前相比差异均有统计学意义(P0.05);CTDR组与ACDF组相比,术后上位邻近节段ROM及C_(2~7) Cobb角差异有统计学意义(P0.05)。CTDR组在末次随访时共有15例患者出现异位骨化,2例假体下沉,1例椎体前缘骨赘吸收。ACDF组无椎间融合器下沉、植骨不愈合、畸形愈合、内固定松动断裂等并发症发生。结论 CTDR在早期恢复独立生活能力方面优势明显,中期随访可较好维持颈椎生理曲度及置换节段ROM,减少相邻节段的异常活动,保护邻近椎间盘,但中期随访发现有异位骨化发生。     

Clinical and radiological analysis of Bryan cervical disc arthroplasty: eight-year follow-up results compared with anterior cervical discectomy and fusion

Purpose

Bryan cervical disc arthroplasty has been reported with satisfactory short- and medium-term clinical results. However, the long-term clinical and radiographic outcomes are seldom reported. The purpose of this study was to compare the eight-year follow-up results in patients who underwent Bryan disc arthroplasty with patients received ACDF, and assess the incidence of heterotopic ossification (HO) and its effect on clinical outcome and mobility of the device.

Methods

Thirty-one patients underwent Bryan disc arthroplasty, and 35 patients underwent ACDF were included in the study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS) of neck and arm pain, and the radiographs were used to evaluate the outcomes. The heterotopic ossification (HO) was determined by CT scan and was classified into three subgroups to compare the related effect. Adjacent segment degeneration (ASD) was also observed.

Results

At final follow-up, there were no significant differences in JOA scores between two groups, but the improvement in NDI and neck or arm VAS were significantly greater in the Bryan disc cohort. The range of motion at the index level was 7.0° in Bryan group, while 100 % bone fusion were achieved in ACDF group. HO was observed in 18 (51.4 %) levels. There were more restricted movement of the prosthesis and slight higher rate of axial pain in patients with severe-HO (grade III and IV). Fourteen (28.6 %) levels developed ASD in Bryan group, which was significantly lower than that (58.6 %) in ACDF group.

Conclusions

At eight year follow-up, the clinical and radiographic outcomes of Bryan cervical disc arthroplasty compared favorably to those of ACDF. It avoided accelerated adjacent segment degeneration by preserving motion. However, severe HO restricted the ROM of the index levels and maybe associated with post-operative axial pain.

     

Prestige LP人工椎间盘置换治疗单节段颈椎病的近期疗效

目的：探讨应用Prestige LP人工椎间盘置换治疗单节段颈椎病的近期临床疗效。方法治疗单节段颈椎病患者15例,统计并分析患者术前和术后1、3、12个月随访时JOA评分、NDI脊髓功能评分、颈部及上肢疼痛VAS评分、置换节段活动度、颈椎运动范围、颈椎生理曲度等指标。结果神经系统症状均有不同程度改善,术后1、3个月及12个月时颈椎生理曲度较术前比均有显著性差异（P＜0.05）。术后1、3个月及12个月时颈椎的总活动度、置换节段活动度基本恢复至术前水平,二者无显著性差异（P＞0.05）。所有患者均未发生脊髓及神经根损伤、假体移位或异位骨化等并发症。结论应用Prestige LP人工椎间盘置换术治疗单节段颈椎间盘退变性疾病早期临床疗效良好,中远期疗效有待进一步观察。