椎间盘镜下腰椎钉棒置入内固定椎间融合植入物的特点与选择

背景：目前临床椎间盘镜下钉棒置入内固定腰椎融合植入物材料有天然生物材料、人工合成材料以及复合材料,它们都存在各自不同的优缺点。目的：分析与总结椎间盘镜下钉棒置入内固定腰椎融合植入物的特点,并探讨如何根据植入物的特点进行选择最合适腰椎内固定融合植入物。方法：在万方数据库及Medline数据库中检索1999-01/2010-12有关椎间盘镜下钉棒置入内固定植入物的研究,关键词为“椎间盘镜,钉棒内固定腰椎融合,植入物”。结果与结论：由于椎间融合器的尺寸符合内窥镜通道的要求,因而椎间融合器的应用逐渐成为目前椎间盘镜下钉棒置入内固定腰椎融合中最主要的手术方式。腰椎间融合器材料由最初的惰性材料钛合金发展至可降解、可吸收生物材料,异体皮质骨材料融合器也已出现,它最为接近所谓的“金标准”。每种椎间融合器都有各自的优缺点,应根据患者腰椎影像学表现及内固定植入物的特点选择最合适内固定植入物。     

前屈后伸载荷下颈椎间孔的孔径变化：Bryan颈人工椎间盘置换与颈椎钢板植骨内固定的比较

背景：诸多针对脊椎椎体间固定融合后相邻节段应力变化的生物力学测试结果并不尽相同,载荷控制与位移控制试验模式下所反映出的相邻节段应力状况其结果也相差甚远。 目的：分析椎间盘完整、椎间盘切除、Bryan颈人工椎间盘置换和前路颈椎植骨融合钢板内固定后,成人尸体颈椎标本分别在前屈后伸载荷下C5/6椎间孔孔径和面积的变化情况。 方法：分别测量C5/6椎间盘完整、椎间盘髓核摘除、Bryan颈人工椎间盘置换和前路钢板植骨内固定4种状态下以0.25,0.50,0.75,1.00,1.25,1.50 N•m的分级载荷加载于标本的前屈后伸状态时C5/6椎间孔孔径和面积的变化情况。 结果与结论：前屈后伸各级加载时,C5/6椎间孔上下径、上前后径、下前后径和面积椎间盘完整组、Bryan颈人工置换组和钢板植骨内固定组高于椎间盘髓核摘除组,差异有显著性意义(P < 0.05),Bryan颈人工置换组高于钢板植骨内固定组,差异有显著性意义(P < 0.05),可见颈椎间盘髓核摘除后C5/6椎间孔有效空间明显减少。     

RF系统与Cage椎间融合器治疗腰椎滑脱症24例临床分析

腰椎滑脱症是临床上较为常见的脊柱疾病,常分为真性滑脱和假性滑脱。腰椎滑脱严重时挤压到对应神经根时常产生腰痛、单侧或双侧下肢疼痛、麻木、间歇性跛行、二便异常等症状。我院2007-06—2010-06应用RF脊柱内固定系统结合Cage椎间融合器融合治疗有神经受压症状Ⅰ、Ⅱ度滑脱患者24例,临床效果满意。现报告如下。     

置入椎间融合器行腰椎融合后Cage移位的原因

背景：多数情况下行后路腰椎椎间融合患者发生Cage移位需再次手术翻修,但翻修手术难度大,效果也常不确切。 目的：分析影响后路腰椎椎间融合后Cage移位的相关因素。 方法：回顾性分析中南大学湘雅三医院2004-01/2010-01进行后路腰椎椎间融后发生Cage移位的16例患者及由外院转入的4例同类患者的临床资料,观测病变节段内置入Cage的数目、Cage的置入深度、Cage与椎体终板贴合程度、椎弓根钉系统的稳定性及病变节段椎间隙高度恢复情况等指标。 结果与结论：病变节段使用单枚Cage融合9例,使用双Cage融合11例。Cage置入深度不足者12例,Cage与椎体终板贴合不佳者10例、病变节段椎间隙高度未恢复者8例,椎弓根钉置入位置错误者2例,椎弓根钉螺帽松动者4例。结果说明 Cage的设计、选择、初始置入位置,椎间隙高度的恢复及配合应用椎弓根钉系统的情况可能影响Cage在宿主体内的稳定性。     

颈椎前路一体化钢板椎间融合器置入后与颈椎生物力学环境的匹配

背景：研究表明,颈椎一体化前路钢板融合器比现行钢板和融合器具有更多理论上的优势。但是目前有关其生物力学方面的研究国内尚无文献报道。 目的：观察与评价颈椎前路一体化钢板椎间融合器内固定置入后的生物力学特征。 方法：采集6具成人尸体颈椎标本,分为5组进行测试,即正常组、椎间盘摘除组、颈椎前路一体化钢板椎间融合器固定组、CBK融合器固定组及CBK融合器+Secuplate钢板联合固定组,以C5~6椎间隙为观察对象,进行生物力学实验。 结果与结论：颈椎间盘摘除后,颈椎在各个方向运动加大,刚度及强度等生物力学数值减小,脊柱失稳。与椎间盘摘除组相比,颈椎前路一体化钢板椎间融合器固定后其强度增加24%,椎体应变减小31%,刚度增加14.3%,位移减小15%(P < 0.05),颈椎前路一体化钢板椎间融合器对颈椎的力学性能影响较小,说明它能较好地与颈椎的力学环境相匹配。CBK融合器固定后抗后伸及旋转作用相对较小,同椎间盘摘除组相比差异有显著性意义(P < 0.05)。CBK融合器+Secuplate钢板联合固定组载荷强度和应变过大,与椎间盘摘除组相比其强度增加27%,椎体应变减小38%,刚度增加17%,位移减小17% (P < 0.05),颈椎刚度增大且邻近椎节的运动有增大趋势,将引起力学性能的改变。提示颈椎前路一体化钢板椎间融合器结合了颈椎前路钢板和融合器生物力学方面的优点,能较好地与颈椎的力学环境相匹配。     

单侧椎弓根螺钉置入并椎间融合对邻近椎间盘节段退变的影响

背景：坚强内固定和良好融合存在严重缺陷和不足。目前还未见临床应用单侧椎弓根螺钉固定结合椎间cage植骨融合治疗腰椎退变性疾病对邻近节段退变影响的相关报道。 目的：回顾分析单侧椎弓根螺钉固定结合椎间cage植骨融合治疗部分腰椎退变性疾病后对固定融合邻近上下节段退变的影响。 方法：2006-03/2009-12对收治的部分腰椎管狭窄症、腰椎失稳及腰椎间盘脱出症患者22例,进行了单侧椎弓根螺钉固定加椎间cage植骨融合,术中不显露对侧。在固定融合后3,6,12,20个月及取出内固定钉棒后3,6个月,随访X射线片及MRI。针对X射线片运用角平分线法测量固定融合邻近上位椎间隙高度变化,MRI测量椎间盘髓核退变情况。 结果与结论：所有病例获得随访,患者椎管狭窄症状及神经根性症状消失,并且在随访期间内没有新的临床症状出现。固定融合前、固定融合后3,6,12,20个月邻近节段上位椎间隙高度分别为(7.420±0.035 4),(7.426 6±0.036 9),(7.453 3±0.036 9),(7.516 6±0.036 9),(7.430 8±0.036 9) mm,结果表明,腰椎单侧固定融合后邻近节段椎间隙高度无明显变化(P > 0.05)。MRI测量结果显示,固定融合邻近上位椎间盘髓核信号在T2加权像无明显退变。提示单侧椎弓根螺钉固定结合椎间融合治疗部分腰椎退变性疾病能有效预防固定融合邻近上下节段退变。     

颈前路钢板置入内固定加椎间植骨治疗Ⅱ型Hangman骨折的生物力学评价

背景：C2/3椎间盘切除,钢板置入内固定加椎间植骨是治疗Hangman骨折的常用术式。该术式在临床应用广泛,但目前尚缺乏相关实验评价钢板置入内固定治疗Hangman骨折的生物力学特点研究。目的：评价钢板置入内固定+椎间植骨治疗Ⅱ型Hangman骨折的生物力学稳定性。方法：6具正常成人新鲜冷冻颈椎,每一标本依次制作成以下3种状态组：即正常对照组、Ⅱ型Hangman骨折模型组、椎间植骨+钢板内固定组。按以上顺序应用脊柱三维运动试验机和三维激光扫描仪测试每一状态C2/3节段的三维运动范围。结果与结论：与正常对照组比较,Ⅱ型Hangman骨折模型组C2/3节段前屈、后伸、旋转及侧弯关节活动度均显著增大(P < 0.05),钢板内固定+椎间植骨组旋转方向关节活动度显著增大(P < 0.05);与Ⅱ型Hangman骨折模型组相比,钢板内固定+椎间植骨组C2/3节段前屈、后伸及侧弯关节活动度均显著减小(P < 0.05)。结果提示钢板置入内固定能够在前屈、后伸及侧弯方向恢复Ⅱ型Hangman骨折的稳定性,然而在旋转方向缺乏稳定作用,术后需辅以外固定以确保融合。     

单枚融合器行经椎间孔腰椎椎体间融合的解剖学观测

背景：有部分学者认为,与经椎间孔腰椎椎体间融合技术相关的手术器械是按照西方人体格设计,和国人体格存在一定的差异,甚至融合物难以置入,所以探讨相关的解剖技术就显得很有必要。 目的：测量腰椎椎间孔及与经椎间孔腰椎椎体间融合相关的解剖参数。 方法：对14具正常成人尸体脊柱腰段椎间孔宽度、长度、高度进行了观测;对腰椎各结构与后正中矢状面的距离进行了观测。 结果与结论： 结果表明腰段(L1~ L5)椎间孔宽度逐渐变小;L1 ~ L4椎间孔高度逐渐增大,L5略小于L4,L1 ~ L5高度均明显大于其宽度(P < 0.01);L1 ~ L5椎间孔长度逐渐增大(P < 0.05)。L1至L5 椎板峡部宽、下关节突最外侧缘至后正中矢状面距离逐渐增大,其性别间、左右间差异均无显著性意义(P > 0.05)。结果表明国人经椎间孔入路能满足高度9~14 mm单枚椎间融合器斜向置入,单枚椎间融合器置入不会因牵拉硬膜囊和神经根而导致脊髓与神经根损伤。     

可吸收椎间融合器的理论研究及临床应用

学术背景：椎间融合器在脊柱外科手术中应用发展迅速。传统椎间融合器的内在缺陷（包括术后沉降、不透光性、应力遮挡效应、手术节段迟发性炎症和骨质疏松等）给与可吸收椎间融合器发展的契机。相比传统椎间融合器,它具有更好的刚度和弹性系数,对影像学评估干扰更小等诸多优势。 目的:介绍可吸收椎间融合器的材料类别与属性、动物实验、临床应用以及目前存在的问题和发展前景,为可吸收椎间融合器的研究和临床应用提供客观依据。 检索策略：由该论文的研究人员应用计算机检索Pubmed数据库1990-12/2006-12的相关文献,检索词"Bioresorbable cage,spine, SCI",并限定文章语言种类为English。共检索到550篇文献,对资料进行初审,纳入标准：有关可吸收椎间融合器的材料研究、动物实验研究、临床研究。排除标准：重复研究。 文献评价：文献的来源主要是关于可吸收椎间融合器的材料研究、动物实验研究、临床研究。所选用的27篇文献中,1篇为综述,其余均为临床或基础实验研究。 资料综合：①材料研究：多聚乳酸是目前研究最多的应用于可吸收椎间融合器的材料;可吸收材料的属性包括结晶性、平均分子量、分子量分布性(多分散性)以及玻璃转化温度。当其应用于椎间融合器时还要考虑降解相关参数、功能降解速度、周围炎症反应以及降解后周围组织填充等因素。②动物实验：四足动物作为动物模型有重要的研究价值也存在一定缺陷;离体实验研究集中在可吸收椎间融合器降解特性及维持脊柱弹性方面的特性;体内实验研究包括其生物力学特性、降解特性、融合特性及异物反应等方面的属性。③临床应用：可吸收椎间融合器在腰椎PLIF,TLIF术及颈椎ACDF术中临床应用短期随访临床效果满意。④可吸收椎间融合器也存在一些应用风险,为降低这些风险带来了相应技术的发展。 结论：可吸收椎间融合器的研究和应用仍处于起步阶段,但现有的研究结果已经预示了其进一步研究和临床应用发展前景。     

经皮加压钢板系统和倒置微创内固定系统置入治疗老年股骨转子间骨折的半年随访

背景：近年来以股骨近端髓内钉、防旋股骨近端髓内钉为代表的髓内固定系统治疗股骨转子间骨折报道较多,但两者比较分析的研究较少。 目的：探讨经皮加压钢板和倒置微创内固定两种治疗股骨转子间骨折的临床效果。 方法：经皮加压钢板置入21例,倒置微创系统置入15例,年龄65~91岁。观察置入后并发症及髋关节功能Harris评分。 结果与结论：全部获得随访6个月,髋关节功能经皮加压钢板组优良率87%,倒置微创内固定组87%。两组患者并发症少,没有患者发生钢板螺钉松动断裂、深静脉血栓形成、髋内翻。提示对于使用髓内固定系统有困难的老年股骨转子间骨折,用此两种微创髓外固定系统也可达到理想的治疗效果。     

Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc herniation: Sequential changes in cage subsidence

Anterior cervical discectomy and fusion with an autogenous iliac bone graft is the gold standard treatment for cervical disc herniation. However, autologous bone grafts obtained from the anterior iliac crest are associated with significant donor-site morbidity and complications. To decrease bone graft-related problems, several types of interbody fusion cage have been developed and are used widely in clinical practice. We compared the clinical and radiological outcomes for two surgical procedures used to treat cervical disc herniation: the stand-alone interbody cage and autologous iliac bone grafting with an anterior plate. The clinical results did not differ between patients treated with the two procedures. The stand-alone cage was less invasive and had less donor-site morbidity. In patients treated with the bone graft and plate, the alignment of the fused segment was maintained in all but one patient, who exhibited nonunion. In contrast, in the cage-treated group, 44% of patients exhibited loss of lordotic alignment of more than 5 degrees and cage subsidence of 3 mm or more. All cage subsidence occurred within 3 months of surgery. Although the stand-alone cage was a less invasive and more effective procedure to treat cervical disc herniation, surgeons should consider the possible drawbacks of the associated subsidence.     

Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: A meta-analysis

Zero-profile device was applied to diminish the irritation of the esophagus in the treatment of cervical degenerative disc disease. However, the clinical application of the zero-profile device has not been testified with clinical evidence. The aim of the meta-analysis was to systematically compare the safety and effectiveness of anterior cervical discectomy and fusion with zero-profile device with plate and cage for the treatment of cervical degenerative disc disease. Electronic searches of PubMed and Embase were conducted up to May 2015. Relevant studies were included. Weighted mean difference (WMD) and 95% confidence intervals (CI) were assessed for continuous data. Risk ratio (RR) and 95% CI were assessed for dichotomous data. P value <0.05 was considered to be significant. Eleven studies were included in the meta-analysis. Compared with plate and cage, zero-p is associated with lower operation time of two-level surgery, less intraoperative blood loss, higher subsidence rate, higher JOA score, lower incidence of dysphagia in short-term (RR: 0.72, 95% CI [0.58, 0.90], P = 0.005, I² = 22%) and long-term (RR: 0.12, 95% CI [0.05, 0.30], P < 0.00001, I² = 0%) and lower Cobb angle of multilevel surgery (WMD: −3.16, 95% CI: [−4.35, −1.97], P < 0.00001, I² = 0%). No significant difference was found in one-level and two-level Cobb angle, fusion rate and operation time of one-level and three-level surgery. Both zero-p implantation and the plate and cage have respective advantages and disadvantages.     

退变椎间盘的细胞培养

背景：目前尚未见成熟的成年人退行性变椎间盘的细胞培养模型报道,而此模型为建立椎间盘组织工程的细胞学基础。 目的：建立成人椎间盘细胞培养模型,奠定椎间盘组织工程研究的细胞学基础。 设计及地点：对比观察的细胞学实验,在山东省创伤骨科研究所完成。 材料：标本来源于青岛大学附属医院骨科5例确诊为退行性椎间盘病变患者。L2~3椎间盘1例,L4~5椎间盘3例,L5~S1椎间盘1例。 方法：对5例取自腰椎间盘突出症退变椎间盘的手术标本,采用系列酶消化法细胞培养和组织块细胞培养两种方法,应用HAMF12培养基加体积分数为10%和20%的胎牛血清分别进行了细胞培养,均获得了传代,并对培养细胞进行了光镜和电镜的形态学观察。 主要观察指标：①细胞生长状况。②光镜下细胞形态观察。③透射电镜超微结构观察。 结果：酶消化法和组织块法均能获得大量的退变椎间盘细胞,并成功地进行细胞传代。培养细胞的分泌物质可能对细胞的生长起一定的限制作用,去除该物质后细胞可迅速增生。但在细胞生长及增殖过程中,体积分数为20%胎牛血清下细胞增殖速度明显高于体积分数为10%胎牛血清时的速度。全部退变椎间盘标本中均发现了脊索细胞。 结论：成人退变椎间盘可以用来获得椎间盘组织工程所需的细胞。     

Influence of diabetes mellitus on cervical intervertebral disc herniation

OBJECTIVES: To establish if patients treated surgically for cervical disc disease have an increased incidence of diabetes mellitus. PATIENTS AND METHODS: We prospectively studied 66 consecutive patients who were treated surgically for cervical disc disease and compared them with 100 age-matched patients at the same time period who underwent surgery for other reasons. RESULTS: There was a significantly increased incidence of diabetes mellitus in the first group. This increased incidence was even higher than that in historical controls treated surgically for lumbar disc disease. Short-term postoperative prognosis was good in our patients. We describe the relationship between diabetes mellitus and cervical disc disease. CONCLUSION: There is an increased incidence of diabetes among patients undergoing surgery for cervical disc disease.     

Posterior percutaneous endoscopic cervical discectomy through lamina–hole approach for cervical intervertebral disc herniation

Background: The optimal PECD surgical approach for cervical intervertebral disc herniation (CIVDH) remains controversial. The conventional posterior K-hole approach for PECD leads to damage of facet joint.

Objectives: This article is to first describe a novel posterior lamina–hole approach of percutaneous endoscopic cervical discectomy (PECD) for CIVDH. The objective of this study is to evaluate the feasibility and short-term clinical effect of this approach.

Methods: Single-center retrospective observational study of all patients managed with posterior percutaneous endoscopic cervical discectomy (PPECD) using the lamina–hole approach for symptomatic single-level CIVDH between January 2015 and January 2016. The clinical outcomes were evaluated with the visual analog scale, modified MacNab criteria and radiographical results.

Results: Twelve patients (seven women, five men) were enrolled in the study. Positive clinical response for pain relief was achieved in these patients receiving PPECD through lamina–hole approach for CIVDH. Postoperative MRI showed complete removal of the disc material in all the patients, no failure due to residual fragment was observed.

Conclusion: As an alternative surgical approach of PPECD, PPECD through lamina–hole approach is a novel access for CIVDH and may be considered a valid and safe therapeutic option for CIVDH. The advantages of this approach are not only providing a valid and secure access to herniated cervical intervertebral fragment but also avoiding the iatrogenic damage to the facet joint and relevant functional spinal unit (FSU). Theoretically, the potential of secondary degeneration of FSU is low.     

程序性死亡分子5在退变腰椎间盘中的表达**

背景：细胞凋亡在腰椎间盘退变中起重要作用。程序性死亡分子5是一个促细胞凋亡的蛋白,在骨关节炎的软骨细胞中表达增高,但是至今未见在退变椎间盘中表达的报道。目的：观察程序性死亡分子5在正常、突出和脱出腰椎间盘髓核细胞中的表达规律,分析其在腰椎间盘退变中的作用。方法：用SP免疫组织化学方法、免疫荧光方法检测程序性死亡分子5在2例正常、23例突出和17例脱出腰椎间盘髓核细胞中的表达,用脱氧核苷酸转移酶末端标记法和透射电镜检测髓核细胞凋亡情况;用天狼星红染色观察髓核组织细胞外基质Ⅰ,Ⅱ型胶原纤维的变化。结果与结论：脱出组髓核细胞表达程序性死亡分子5的阳性率高于突出组(P < 0.05),脱出组髓核细胞脱氧核苷酸转移酶末端标记阳性率高于突出组(P < 0.05)。荧光显微镜和激光共聚焦显微镜观察结果显示程序性死亡分子5表达定位于退变椎间盘的髓核细胞的细胞核;用透射电镜检测到凋亡的髓核细胞;天狼星红染色结果显示,随着年龄增长,髓核中Ⅱ型胶原纤维减少,Ⅰ型胶原纤维增多。结果提示退变椎间盘髓核细胞表达程序性死亡分子5上调,细胞凋亡增加,程序性死亡分子5介导的细胞凋亡在椎间盘退变中起到重要作用。     

Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion

Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. A total of 259 consecutive patients were included in the study, 171 patients in the CDA group with an average follow-up of 9.8 (±9.9) months and 88 patients in the ACDF group with an average follow-up of 11.8 (±9.6) months. Relief of pre-operative symptoms was 90.1% in the CDA group and 86.4% in the ACDF group with rates of return to full pre-operative activity of 93.0% and 88.6%, respectively. Patients who underwent CDA had a higher rate of persistent posterior neck pain (15.8% versus 12.5%), and patients who underwent ACDF were at risk for symptomatic pseudarthrosis at a rate of 3.4%. Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.     

腰椎斜扳手法时椎间盘的有限元分析

背景：利用计算机技术和有限元法分析法研究中医传统的脊柱推拿手法,来解释手法的作用机制、适应证和禁忌证,可为临床上常用的腰椎斜扳手法提供了客观的、科学的理论依据。目的：应用有限元法了解进行斜扳手法时腰椎间盘的内在应力及位移分布的特点。方法：使用正常腰椎CT片,以Mimics软件系统逐层重建,建立L4~5三维有限元模型。根据手法原理,将腰椎斜扳手法进行分解,把各项力学参数代入三维有限元模型进行计算分析。即时显示手法作用时腰椎间盘的位移和内在应力的变化。结果与结论：椎间盘的应力远小于后部结构;从椎间盘中心到右侧有一个向后的扭转矢量,使椎间盘产生变形。结果证明腰椎斜扳手法对椎间盘是安全的,并且在椎间盘突出的对侧进行手法操作更为合理;腰椎椎管狭窄的患者不宜使用腰椎斜扳手法。     

Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访

背景：Bryan人工颈椎间盘置换的短期疗效优良已被大多数学者公认,但有关其中长期临床效果及并发症的资料较少。 目的：总结Bryan人工颈椎间盘置换治疗颈椎病的中期临床效果。 方法：选择2004-11/2007-12在四川大学华西医院骨科接受Bryan人工颈椎间盘置换的颈椎间盘突出症患者34例,其中单节段置换30例,双节段置换4例。于置换前、置换后7 d、3,6,12,24,36,48个月行SF-36生活质量量表评分、JOA评分、颈部及上肢疼痛目测类比评分;以颈椎正侧位及功能位X射线片测量手术节段、邻近节段及C2~7屈伸活动度的变化,手术节段和邻近节段椎间高度变化及手术节段的轴向平移情况。 结果与结论：所有患者置换后神经症状均明显好转,各随访点SF-36生活质量量表躯体评分和心理评分、JOA评分、颈部和上肢疼痛目测类比评分较置换前明显改善(P < 0.05),3个月之后各随访时点两两比较差异无显著性意义(P > 0.05)。置入的Bryan假体历次随访均保留了>2°的活动度,未发现手术节段异位骨化与自发性融合,随访48个月时手术节段及C2~7屈伸活动度较置换前略有增加,但差异无显著性意义(P > 0.05);上下邻近节段屈伸活动度维持了置换前水平;手术节段的椎间高度由置换前的(6.04±1.02) mm增加到(8.44±0.43) mm(P < 0.05);上下邻近节段椎间高度及手术节段的轴向平移均维持了置换前水平。说明Bryan人工颈椎间盘治疗颈椎间盘退变性疾病的中期临床效果良好,较好的保留了手术节段、邻近节段及整个颈椎的运动学特性,且近中期并发症很少。     

Clinical and radiologic comparison of dynamic cervical implant arthroplasty and cervical total disc replacement for single-level cervical degenerative disc disease

Anterior cervical discectomy and fusion, to date the most successful spine procedure for the surgical treatment of cervical radiculopathy, has limitations that have led to the development of non-fusion cervical procedures, such as cervical total disc replacement (TDR) and dynamic cervical implant (DCI) arthroplasty. We compared the clinical and radiological results of DCI and cervical TDR for the treatment of single-level cervical degenerative disc disease in Chinese patients. A retrospective review of 179 patients with cervical spondylotic myelopathy who underwent DCI or TDR between April 2010 and October 2012 was conducted, and 152 consecutive patients (67 patients single-level DCI and 85 single-level TDR) who completed at least 2 years of follow-up were included. Clinical and radiological assessments were performed preoperatively and at 1 week and 3, 6, 12, and 24 months postoperatively. The most common operative level was C5/C6 (49.3%). The differences in blood loss, duration of surgery, and duration of hospitalization were not statistically significant. The Japanese Orthopaedic Association scale, Visual Analog Scale, Neck Disability Index, and Short Form-36 scores improved significantly after surgery in both the DCI and TDR groups (P < 0.05), but the differences were not statistically significant at the final follow-up. The rate of occurrence of heterotopic ossification was 22.4% and 28.2% in the DCI and TDR groups, respectively. As an effective non-fusion technique, DCI is a more economical procedure. Further prospective, randomized studies with long-term follow-up periods are needed to determine the long-term effects.