颈椎人工间盘置换与前路减压融合术治疗单节段颈椎间盘突出症的疗效

目的:探讨Mobi-C颈椎人工间盘置换(cervical artificial disc replacement,CADR)与传统颈椎前路减压融合术(anterior cervical decompression and fusion,ACDF)治疗颈椎间盘突出症的临床疗效。方法:对2009年6月至2012年6月收治的27例单节段颈椎间盘突出症患者进行回顾性分析,男18例,女9例,年龄30~62岁,平均46.7岁。其中12例采用CADR治疗(CADR组),15例采用ACDF治疗(ACDF组)。所有患者有颈肩部及上肢疼痛麻木,病程1~13个月,平均2.4个月。术前、术后1周、末次随访时均进行全面的临床评价和生活质量问卷调查。应用Odom标准评价术后疗效,采用视觉模拟疼痛量表(VAS)记录疼痛级别,用颈椎功能障碍指数(NDI)和健康状况调查问卷SF-36对患者生活质量进行综合评定。结果:27例患者无神经血管并发症发生,均获得随访,平均随访时间16个月(6~30个月)。术后1周CADR组优10例,良2例,ACDF组优5例,良10例,两组疗效差异有统计学意义(χ2=6.75,P=0.019);末次随访时CADR组优10例,良2例,ACDF组优12例,良3例,两组疗效差异无统计学意义(χ2=0.049,P=1.000)。术后1周及末次随访时两组患者的上肢VAS评分均明显缓解(P<0.05)。术后1周:CADR组颈部VAS评分由术前的3.58±0.79下降至0.58±0.51(P<0.05),NDI指数由术前的(23.42±6.36)分下降至(5.42±1.68)分(P<0.05),而ACDF组下降不明显。末次随访时:两组患者的颈部VAS评分、NDI指数及SF-36生活质量与术前比较均有明显改善(P<0.05)。结论:Mobi-C CADR保留了减压节段的运动,允许患者迅速恢复正常的活动,术后早期即可显示明显疗效,且疗效稳定维持,患者的生活质量明显提高。

Analysis of clinical effects of cervical artificial disc replacement or anterior cervical decompression and fusion for the treatment of single cervical disc herniation

Objective: To explore the clinical effects of Mobi-C cervical artificial disc replacement (CADR) and anterior cervical decompression and fusion(ACDF) in treating single cervical disc herniation. Methods: From June 2009 to June 2012,the clinical data of 27 patients with single cervical disc herniation were retrospectively analyzed. There were 18 males and 9 females,aged from 30 to 62 years old with an average of 46.7 years. Of them,12 patients were treated with CADR (CADR group) and 15 patients with ACDF(ACDF group). All patients had pain and numbness in neck,shoulder and upper limbs,and courses of disease was from 1 to 13 months with an average of 2.4 months. The data of clinical evaluation and questionnaire survey about quality of life were collected before operation,postoperative at 1 week and final follow up. Odom criterion was used to evaluate postoperative effect. Visual analogue scale (VAS) was used to record pain levels. Neck disability index (NDI) and health questionnaire SF-36 were used to assess the quality of life. Results: No complications about nerve and blood vessel were found and the patients were followed up from 6 to 30 months,with an average of 16 months. One week after operation,10 cases got excellent results and 2 good in CADR group;5 cases got excellent results and 10 good in ACDF group;there was significant difference between two groups(P<0.05). At final follow up,10 cases got excellent results and 2 good in CADR group;12 cases got excellent results and 3 good in ACDF group;there was no significant difference between two groups(P >0.05). Pain of upper limbs had obviously relieved between two groups at 1 week after operation and final follow up(P<0.05). VAS of neck and NDI in CADR group had decreased respectively from preoperative 3.58±0.79,23.42±6.36 to 0.58±0.51,5.42±1.68 at 1 week after operation(P<0.05);but the index in ACDF group was no obvious at 1 week after operation. At final follow up,VAS of neck and NDI and SF-36 score were obviously improved than preoperation(P<0.05) between two groups. Conclusion: Mobi-C CADR retains the movement unit in the decompression segment and can quickly recover normal action for patients. Using CADR method has a good curative effect in the early phase,and the clinical effect is reliable,may improve the quality of life.