单节段Bryan人工颈椎间盘置换术后异位骨化的发生率和疗效观察

目的评估单节段Bryan人工颈椎间盘置换术后异位骨化发生情况,分析异位骨化对术后疗效影响。方法回顾分析2005年10月-2007年10月48例行单节段Bryan人工颈椎间盘置换术患者临床资料。男27例,女21例;年龄33～51岁,平均40.5岁。脊髓型颈椎病8例,神经根型颈椎病27例,混合型颈椎病13例。病程2～14个月,平均10.3个月。病变节段:C3、43例,C4、56例,C5、630例,C6、79例。术后采用疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、置换节段活动度评价疗效;并将患者按术后是否发生异位骨化分为两组,比较术后1、2、3、4年以上各指标差异。结果患者术中及术后均无严重并发症发生。48例均获随访,随访时间48～72个月,平均56.6个月。术后各时间点VAS评分及NDI均较术前显著改善(P<0.05);除术后3 d,其余各时间点置换节段活动度与术前比较差异均无统计学意义(P>0.05)。术后4年共13例(27.08%)发生异位骨化,其中1级8例,2级3例,3级2例。异位骨化组和无异位骨化组患者术后各时间点置换节段活动度及VAS评分、NDI比较,差异均无统计学意义(P>0.05)。结论单节段Bryan人工颈椎间盘置换术后异位骨化发生率相对较高,异位骨化对人工颈椎间盘置换节段活动度影响较小,对术后疗效无明显影响。

Analysis of effectiveness and incidence of heterotopic ossification after single-level bryan cervical artificial disc replacement

Objective To evaluate the incidence of heterotopic ossification(HO) after single-level Bryan cervical arti cial disc replacement,and to identify the relationship between HO and the e ectiveness.Methods The clinical data of 48 patients undergoing single-level Bryan cervical arti cial disc replacement between October 2005 and October 2007 were reviewed retrospectively.There were 27 males and 21 females with an average age of 40.5 years(range,33-51 years),including 8 cases of cervical myelopathy,27 cases of nerve root cervical spondylosis,and 13 cases of mixed cervical spondylosis with an average disease duration of 10.3 months(range,2-14 months).The involved segments included C3,4 in 3 cases,C4,5 in 6 cases,C5,6 in 30 cases,and C6,7 in 9 cases.The outcomes were evaluated using Visual Analogue Scale(VAS) score,the neck disability index(NDI),and cervical range of motion(ROM).According to patients with or without HO,48 patients were divided into 2 groups(HO group and no HO group).VAS score,NDI,and cervical ROM were compared between 2 groups at 1,2,3,and 4 years after operation.Results No severe complication occurred during and after operation in all patients.Forty-eight patients were followed up 48-72 months(mean,56.6 months).VAS score and NDI were signi cantly improved when compared with preoperative values at all time points(P < 0.05);except at 3 days after operation,no signi cant di erence was found in cervical ROM at the other time points when compared with preoperation(P > 0.05).Thirteen patients(27.08%) had HO at 4 years after operation,including 8 cases of grade 1,3 cases of grade 2,and 2 cases of grade 3.There was no signi cant di erence in VAS score,NDI,and cervical ROM between 2 groups at 1,2,3,and 4 years(P > 0.05).Conclusion The incidence of HO after single-level Bryan cervical arti cial disc replacement is relatively high.However,HO has no e ect on the cervical ROM and the e ectiveness.