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。

Cervical total disc replacement for treatment of single level cervical disc degenerative disease: midterm follow-up results

Objective To observe the mid-term clinical efficacy of cervical total disc replacement(CTDR) in the treatment of single level cervical disc degenerative disease. Methods From January 2009 to October 2011, the clinical data of 81 patients with single level cervical disc degenerative disease and followed up more than 4 years were retrospectively analyzed. The patients were divided into CTDR group(n=41) and anterior cervical discectomy and fusion(ACDF) group(n=40). The Japanese Orthopaedic Association(JOA) score and the neck disability index(NDI) were used to evaluate improvement of the functional status; McAfee classification was used to evaluate the heterotopic ossification; and the differences between the 2 groups were compared. Imaging evaluation was performed by MRI, and the operative and adjacent segments'' range of motion (ROM) and C₂-₇ Cobb''s angle were compared between the 2 groups. Results The postoperative JOA scores and NDI were significantly improved in both groups. At postoperative 1 month, the NDI of CTDR group was significantly better than that of ACDF group, especially in the items such as work, driving and recreation, and the difference was statistically significant(P< 0.05). There was no significant difference in JOA scores between the 2 groups. The change in ROM of upper and lower adjacent segments and C₂-₇ Cobb''s angle was not obvious in CTDR group. The change in ROM of upper adjacent segments and C₂-₇ Cobb''s angle was obvious in ACDF group, and the difference was statistically significant(P< 0.05). The differences in postoperative ROM of upper adjacent segments and C₂-₇ Cobb''s angle were statistically significant between the CTDR group and ACDF group (P< 0.05). In CTDR group, there were 15 cases of heterotopic ossification, 2 prosthesis sinking, and 1 case of resorption of vertebral anterior edge osteopgytes at the final follow-up. In ACDF group, there were no complications such as subsidence of interbody fusion cage, nonunion, malunion and loosening of internal fixation. Conclusion CTDR is an effective choice in the treatment of single level cervical disc degenerative diseasebecause of its significant superior effect in improving the early capacity of independent living. It also facilitates the restoration of cervical segmental motion and cervical sagittal alignment despite radiographic evidence of heterotopic ossification at mid-term follow-up period.