颈人工椎间盘假体置换术的临床应用

目的探索Bryan颈椎间盘假体应用于亚洲人的手术操作要点和早期治疗效果,观察假体植入后的稳定性和植入节段的活动度。方法对8例脊髓型颈椎病患者(10个节段)行颈前路间隙减压,Bryan颈椎间盘假体置换术。手术前和术后3个月进行JOA评分,术后3个月进行Odom评级,评价早期治疗效果;术后1周、3个月摄置换节段前屈后伸位,左右侧屈位X线片,观察稳定性和植入节段的活动度。术后3个月进行置换间隙CT或MRI扫描,进一步确定假体位置和置换部位是否存在早期的异位骨化现象。结果本组患者全部经过至少3个月(平均36个月)的随访,术后患者症状明显缓解、脊髓功能改善,JOA评分由术前平均88(7～12)上升至术后平均158(13～17)。8例患者术后3个月置换节段前屈后伸活动范围平均475°(38～58°);左右侧屈活动范围分别为平均338°(23～44°),和313°(25～41°)。未发现偏移或假体下沉。CT或MRI扫描显示7个节段的假体上、下金属壳位于临近下、上终板骨的中央,1个节段假体偏离<2mm,1个节段假体偏离>2mm、<4mm。未见假体周围的异位骨化现象。结论颈人工椎间盘置换术保持前路减压的良好效果,同时取得了良好的术后稳定性,保持了颈椎正常的活动度,为颈椎病的治疗提供了一种新的选择。

Clinical report of cervical arthroplasty in management of spondylotic myelopathy

OBJECTIVES: To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Asian, to observe the stability and range of movement (ROM) postoperatively. METHODS: Bryan disc prosthesis replacement applied in 8 cases (10 levels) of cervical spondylotic myelopathy (CSM). Clinical (JOA grade and Odom's scale) and radiological (X-ray of bending, extending; left and right bending position) follow-up was performed 3 months postoperatively, (mean follow-up 3.6 month). Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scan were applied in all cases 3 months postoperatively to find out the excursion of the prosthesis and heterotopic-ossification in the replaced levels. RESULTS: At least 3 months follow-up were done in all this patients. There was no complication. Improvement in all of 8 patients according to the Odsm's scale. JOA score increased from average 8.8 to 15.8. There was no prosthesis subsidence or excursion. Replaced segment achieved stability and restored partial of normal ROM, 4.75 degrees (3.8 degrees approximately 5.8 degrees ) in flex and extension position and 3.38 degrees (2.3 degrees approximately 4.4 degrees ), 3.13 degrees (2.5 degrees approximately 4.1 degrees ) in left and right bending position. No obvious loss of lordosis was found. CT or MRI follow-up show excursion (<2 mm) in 1/10 levels; (<2 mm excursion <4 mm) in 1/10 levels, and no heterotopic ossification in the replaced levels. CONCLUSIONS: Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post operational images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM in Asian.