人工颈椎间盘假体置换术治疗脊髓型颈椎病的临床效果

目的 评价人工颈椎间盘假体置换术治疗脊髓型颈椎病患者的临床效果。方法 应用Bryan颈椎间盘假体置换术治疗脊髓型颈椎病患者20例（22个节段），术前和术后1个月、3个月、12个月、24个月进行JOA、ODI评分评价临床疗效，并行颈椎正侧位、动力位X线片及CT、MRI检查，观察植入假体的稳定性及颈椎置换节段的活动度。结果 术后经过24个月的随访，JOA评分增高、ODI评分降低，临床症状较术前明显改善，虽然置换节段早期的活动度较术前有所减小，但长期随访示恢复了术前的活动范围，保持了正常的颈椎运动功能。置换节段假体位置稳定无移位，未发现植入物下沉和异位骨化现象。结论 人工颈椎间盘置换术不但可以保持颈前路减压的良好效果，还可重建颈椎的运动功能。     

Clinical and radiographic results of cervical artificial disc arthroplasty: over three years follow-up cohort study

Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.     

Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty

Background Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments. The efficiency of posterior longitudinal ligament （PLL） resection in anterior cervical decompression and fusion has been demonstrated. However, no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty. This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.     

COA: Bryan人工椎间盘置换术3年以上随访的临床效果

背景：颈椎人工间盘置换术作为一种新的技术,近年来在脊柱外科领域广泛应用。它具有保留手术节段活动,保留置换节段的生物力学环境,减少临近节段退变等优点。尽管颈椎人工间盘置换的短期临床效果已经得到了肯定,但是中期的临床效果尚缺乏报道。 材料与方法：对2003年12月到2006年1月行颈椎人工间盘置换术的50例患者进行了随访。其中单节段颈椎人工间盘置换39例,双节段颈椎人工间盘置换11例。随访时年龄29-73岁（平均年龄50.9岁）。随访时间36.0-55.63个月,呈偏态分布,中位数为41.85个月,四分位数间距为8.71个月。。记录患者症状、神经系统体征及影像学情况。 结果：JOA评分中位数术前为14.0,末次随访时为16.5,两者间差异有统计学意义（P<0.01）,JOA评分改善率中位数为92.17%。末次随访置换节段过屈过伸活动度8.56°±4.76°与术前置换节段过屈过伸活动度10.4°±4.97°呈正相关并有统计学意义（P<0.05,r=0.33）。末次随访时置换节段活动度与术后三个月7.52°±3.37°相比略有增加,并有统计学意义（P<0.05）。术前中立位置换节段的曲度-0.96°±6.52°与末次随访时中立位置换节段的曲度-2.65°±7.95°有相关性（r=0.53,P<0.01）,差异无统计学意义（P>0.05）。术前中立位置换节段的终板间夹角为2.61°±4.85°与末次随访时置换节段的中立位假体终板间夹角0.71°±6.41°无相关性,差异无统计学意义（P>0.05）。 结论：Bryan人工间盘置换术3年随访的疗效是满意的,颈椎置换节段的生理运动范围及生物力学环境得到了较好的保持。     

Incidence and risk factors analysis of heterotopic ossification after cervical disc replacement

Background Cervical disc replacement （CDR） as a substitute for traditional fusion surgery has been widely used in treating degenerative cervical disc diseases.The objectives of this study were to assess the clinical and radiological findings for patients with heterotopic ossification （HO） following CDR and to detect the risk factors of HO after CDR.Methods A total of 125 patients with symptomatic cervical single-or double-level disc diseases,who underwent CDR procedure with Discover prosthesis in Department of Spine Surgery,Changzheng Orthopedics Hospital from March 2009 to March 2011,were enrolled in this retrospective study.Occurrence of HO was defined by the McAfee classification on cervical lateral X-rays in this study.Prosthesis vertebral ratio （PVR） was used to determine the matching degree between the cervical disc prosthesis and cervical vertebra.Logistic regression analyses were performed to determine the risk factors of HO.Variables evaluated for their association with HO occurrence included age,gender,high-intensity signal in spinal cord,preoperative range of motion （ROM）,postoperative ROM,operation level number,and PVR.Results Mean follow-up time was （26.4±5.8） months.All the patients had significant symptoms and neurological function improvements during the follow-up period.The ROM of the operated segment from the preoperative period to the last follow-up was relatively well maintained.The rate of HO in this cohort of patients,who underwent Discover disc,was 27.92％ per surgical level and 24.8％ per patient by the last follow-up.There were 19 patients （19.79％） with HO in the single-level group while 12 patients （41.38％） in the double-level group.Conclusions We identified preoperative high-intensity signal in spinal cord,postoperative ROM of surgical level,number of operation level,and PVR as significant risk factors for postoperative HO occurrence.     

颈椎融合术对邻近节段矢状位活动度影响研究

目的 探讨颈椎融合术对颈椎邻近节段矢状位活动度的影响.方法 应用回顾性研究的方法,选取北京积水潭医院1999年1月至2006年12月颈前路减压融合手术患者28例,收集患者术前及末次随访影像学资料,评价植骨融合率、融合节段近端、远端节段矢状位活动度、下颈椎整体矢状位活动度.结果 患者术后平均随访(6.3±1.6)年,X线评价融合节段融合率为100%,对融合节段上、下邻近节段矢状位活动度术前与随访相比较,无统计学差异.而下颈椎矢状位总体活动度明显下降,单节段融合术前(46.8±13.4)°,随访时(36.8±9.6)°,差异有统计学意义(t=3.042,P=0.007),活动度平均减少16.8%;而双节段融合术前48.6°±14.6°,随访时(39.9±7.2)°,差异有统计学意义(t=5.064,P＜0.01),活动度平均减少35.6%.结论 颈椎融合手术仍是颈椎结构重建的良好方法,短节段融合术并没有增加邻近节段的屈伸活动度,而对下颈椎整体屈伸活动度有一定影响.     

颈椎间盘置换术治疗颈椎病的短期疗效观察

目的:探讨颈椎间盘置换术治疗颈椎病的临床疗效。方法:观察2010年3月～2011年1月期间皖南医学院附属弋矶山医院脊柱外科采用颈椎间盘置换术治疗颈椎病患者20例;记录并比较术前、术后3个月及末次随访患者的颈椎JOA评分、椎间高度、颈椎活动度和脊柱功能单位活动度。结果:平均随访(18.9±7.23)个月。患者临床症状明显缓解。JOA评分、椎间高度术前与术后、末次随访差异有统计学意义(P<0.05)。颈椎活动度和脊柱功能单位活动度术后及末次随访数据与术前比较差异均无统计学意义(P>0.05)。结论:在严格把握手术适应证和禁忌症的情况下,颈椎间盘置换术可取得满意的临床疗效,同时可预防和减少邻近节段退变的发生,值得临床推广应用。     

单节段颈椎人工椎间盘置换术临床疗效探讨

目的探讨单节段颈椎人工椎间盘置换术临床疗效。方法对我院32例患者经单节段颈椎人工椎间盘（ActivC型）置换术。术后6周、3个月、6个月、12个月、18个月复查拍摄颈椎前屈后伸动力位X线片,观察置换组假体稳定性。同时进行术后系列调查评分,对治疗结果进行回顾性分析。结果手术组术后早期吞咽困难、颈痛、上肢疼痛等发生率明显降低（P〈0．05）。人工颈椎间盘置换组置换前后邻近节段活动范围差异无统计学意义（P〉0．05）。结论单节段颈椎人工椎间盘置换术后早期并发症减少,中期能保护相邻节段退变。     

使用颈椎动态稳定器非融合颈椎的早期疗效分析

目的 随访评价颈椎动态稳定器非融合颈椎治疗颈椎间盘突出症的早期疗效.方法 回顾性分析13例使用颈椎动态稳定器治疗颈椎间盘突出症的临床资料.采用JOA评分及PSI评分对患者术前及术后1周、1个月、6个月疗效情况进行记录和分析,根据颈椎x线片观察患者术前、术后DCI植入节段及相邻节段的运动范围.结果 13例病例获6个月随访.术前JOA评分7.8～11分,平均（8.82±0.78）分,术后6个月评分12.3～16分,平均（15.13±0.52）分,术后与术前相比,差异有统计学意义（P=0.001）;术后平均PSI为1.6分;术前邻近节段的平均活动范围为（8.38±4.62）°,术后为（7.72±3.62）°,与术前相比,平均减少了（0.66±0.36）°,但差异无显著性（P＞0.05）.疗效评定：优10例,良3例,手术有效率为100％.结论 使用颈椎动态稳定器非融合颈椎,在非融合的情况下提供颈椎动态稳定性,同时未明显改变手术邻近节段的活动度,具有良好的早期临床疗效.     

人工颈椎间盘置换术治疗颈椎病12例近期疗效分析

目的观察人工颈椎间盘置换术治疗颈椎病的短中期疗效。方法对人工颈椎间盘置换术12例（13个节段）患者随访术后假体的位置、有无异位骨化、置换节段的运动范围变化,并用JOA评分及术后Odom评级评价临床疗效。结果随访3～12个月（平均6.5个月）,患者的JOA评分由术前的平均8.35±1.10上升至术后末次随访时的15.88±0.73（P〈0.05）;Odom评级优良率达到91.7%。置换节段的运动范围变化：过屈过伸活动度由术前的8.09°±0.63°上升到术后12个月的8.95°±0.64°（P〈0.05）;左侧屈曲活动度术前为6.11°±0.53°,术后12个月为6.25°±0.54°;右侧屈曲活动度术前为6.10°±0.52°,术后12个月为6.13°±0.51°。手术前后两侧屈曲活度差异均无统计学意义（P〉0.05）。未发现假体松动或下沉及异位骨化。结论人工颈椎间盘置换术的短中期疗效是令人满意的。     

人工颈椎间盘置换手术的临床初步应用体会

目的 探讨颈椎Bryan人工间盘置换手术的临床使用要点和手术适应证。方法 对2003年12月至2004年6月北京积水潭医院脊柱外科共进行的29例33个椎间盘的颈椎人工间盘的置换手术进行了随诊。随诊时间最长6个月,平均3．7个月。其中脊髓型颈椎病16例,颈椎间盘突出症13例。单间隙25例,双间隙4例。其中男15例,年龄32～60岁,平均47岁。女14例。年龄40～65岁,平均49岁。本组病例均采用Bryan人工椎间盘假体,该假体采用外壳和聚氨酯髓核构成。假体上下终板接触面有钛微孔喷涂层利于骨长入。从而使假体获得长期稳定性。手术严格按照Bryan人工椎间盘假体置入标准操作程序进行。术后颈托外固定2周。结果 JOA评分改善率56％。椎间活动度：矢状位术前平均活动度12．2度,术后10．9度,冠状面平均5．7度,邻近间隙矢状位术前平均活动度10．9度,术后9．4度,患者满意度94％。与一般前路同定术比较,患者恢复快,早期可以颈部活动,颈部僵直感少。结论 29例33个人工间盘置换手术取得满意的近期疗效,颈椎运动范围得到一定保持。与前路融合手术最大的不同是患者恢复快,颈部支具佩带时间短,没有颈椎受限的感觉。     

DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病的早期疗效观察

目的探讨应用DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病的早期临床疗效。方法回顾性分析行DISCOVER人工颈椎间盘置换术的12例脊髓型颈椎病患者的临床资料,统计并分析患者术前和术后神经功能状态JOA评分和颈椎总活动度（ROM）,进行早期疗效评估。结果所有患者随访6个月,术后临床症状和体征明显改善或消失,JOA评分由术前的（6．79±3．62）分提高到末次随访的（15．84±0．89）分（P〈0．05）;ROM术前为（51．3±14．2）°,术后末次随访为（49．9±13．8）°,差异无统计学意义（P〉0．05）。按照Odom评定标准,末次随访时,优9例,良2例,可1例,优良率91．7％。结论应用DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病早期疗效良好,远期效果有待进一步观察。     

颈椎动态稳定器治疗单节段颈椎病的回顾性研究

目的 回顾性研究颈椎动态稳定器（dynamic cervical implant,DCI）治疗颈椎病的手术治疗效果。方法 对16例颈椎间盘切除减压DCI植入的颈椎病患者进行了回顾性研究,手术节段包括C4-5、C5-6、C6-7,其中C4-5节段3例,C5-6节段7例,C6-7节段6例,分别在术前、术后3个月、6个月、1年获得了完整的随访资料。临床评分采用疼痛视觉模拟评分（visual analogue score,VAS）和颈椎功能障碍指数（neck disability index,NDI）分别进行术前术后疗效的对比。记录手术时间、术中出血量,观察颈椎过伸过屈位X线片评价假体的稳定性,是否有假体位移、下沉,以及邻近节段活动度等的影像学表现。结果 术后3个月、6个月、1年的资料显示NDI评分、颈痛VAS和上肢痛VAS与术前评分相比,差异均有统计学意义（P<0.05）。手术节段保留明显的活动度,相邻节段未见到明显的退变不稳。随访过程未见到假体松动、移位,围手术期无明显神经损伤、感染病例。结论 单节段颈椎病前路间盘切除减压DCI动态内固定术具有良好的手术治疗效果,术后1年随访显示该术式保留手术节段和邻近节段的活动度,维持改善患者颈椎的矢状面曲线。     

Bryan artificial cervical disc arthroplasty in a patient with Klippel-Feil syndrome.

Technological advances have made more options available for surgical intervention in spinal disorders. From spinal fusion to artificial disc implantation, these advancements have brought great benefits, allowing preservation of spinal motion and flexibility after intervertebral discectomy. Yet the use of artificial discs as a treatment for congenital spinal disorders has been documented in only a handful of publications. We report a case where a Bryan artificial cervical disc arthroplasty was used to maintain and preserve the mobility and function of the cervical motion segments adjacent to fused vertebral lesions in a 33-year-old woman with Klippel-Feil syndrome who presented with chronic neck pain and signs of early myelopathy. The rationales for using the Bryan disc prosthesis system in patients with Klippel-Feil syndrome and its advantages over conventional surgical interventions are discussed.     

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cer- vical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases re- ceived two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthope- dic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially re- stored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°), 3.42° (2.6° -4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recov- ery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.     

单侧半椎板及不同程度小关节切除术对羊颈椎生物力学的影响

目的:构建颈椎单侧半椎板以及不同程度小关节切除的动物模型,分析单侧半椎板以及不同程度小关节切除对颈椎生物力学的影响。方法:将20只实验羊随机分为A、B、C、D 4组,每组5只。A组为空白对照组,B组实施C4-C6右侧半椎板切除术,C组实施C4-C6 右侧半椎板+50%右侧C4-C5小关节切除术,D组实施C4-C6右侧半椎板+100%右侧C4-C5小关节切除术,各组常规饲养24周后处死并获得新鲜颈椎标本。比较术后24周生物力学改变:在脊柱三维运动试验机上,模拟生理活动状态对A、B、C和D组颈椎标本进行生物力学测定,并比较颈椎活动度差异。结果:(1)术后24周颈椎总活动度:D组在屈伸下的活动度(60.2° ±8.6°)显著大于A组(40.7°±6.4°)和B组(41.2°±13.1°);D组在侧弯状态下的活动度(81.5°±15.7°)显著大于A组(56.7°±12.2°)和B组(57.7°±12.8°);D组在旋转状态下的活动度(38.5°±17.5°)较A组(26.4°±9.9°)和B组(27.1°±10.9°)无明显增加;C组在屈伸状态的活动度(44.1°±11.7°)、侧弯状态下的活动度(73.6°±11.4°)及旋转状态下的活动度(31.3°±11.5°)较A组和B组无明显增加;(2)术后24周节段间活动度:D组在屈伸状态下的C4-C5活动度(20.3°±4.6°)显著大于A组(11.7°±3.4°)和B组(11.9°±2.1°),在侧弯状态下的C4-C5活动度(26.8°±3.5°)显著大于A组(15.2°±3.1°)和B组(16.2°±3.2°),在旋转状态下的C4-C5活动度(15.2°±3.5°)显著大于A组(6.6°±2.3°)和B组(7.1°±1.9°);C组在侧弯状态下的C4-C5活动度(21.2°±4.1°)显著大于A组和B组,在屈伸状态下的C4-C5活动度(15.7°±3.7°)及旋转状态下的C4-C5活动度(10.3°±3.1°)较A组和B组无明显增加。结论:单纯半椎板切除术不影响颈椎稳定性,半椎板合并50%同侧小关节切除不影响术后远期的颈椎稳定性,半椎板合并100%同侧小关节切除会明显降低术后远期在侧弯和屈伸下的颈椎稳定性。     

人工颈椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的对照研究

目的比较人工颈椎间盘置换术与颈前路减压融合术治疗脊髓型颈椎病的疗效,评价其优缺点。方法65例脊髓型颈椎病患者按照手术方式分为人工颈椎间盘置换术组（33例,行Bryan假体置换术）和颈前路减压融合术组（32例,行颈前路减压融合术）。观察两组患者住院时间、术后颈部外固定时间以及术后恢复工作时间;两组患者于术前、术后3、6、12个月行13本矫形外科协会（JOA）评分,并行X线检测颈椎活动度（ROM）;评价临床疗效及术后并发症。结果人工颈椎间盘置换术组患者住院时间、术后颈部外固定时间以及术后恢复工作时间均显著短于颈前路减压融合术组（P〈0．01）。两组术后12个月JOA评分均较术前明显提高（P〈0．05）,两组差异无统计学意义（P〉0．05）。人工颈椎间盘置换术组术后12个月单节段及双节段置换ROM较术前无显著改变（P〉0．05）,颈前路减压融合术组术后12个月ROM较术前减小（P〈0．05或P〈0．01）,且显著小于人工颈椎间盘置换术组（P〈0．05或P〈0．01）。两组患者满意率无差异（P〉0．05）。两组术后均无严重并发症发生。结论人工颈椎间盘置换术治疗脊髓型颈椎病患者术后恢复快,住院时间短,颈部外固定时间短,使患者保持正常的颈椎活动度,临床疗效好,值得临床推广使用。     

Cervical Disc Replacement for Spondylotic Myeloradiculopathy

Background

Cervical disc replacement is a newer concept and rapidly developing surgical treatment. A prospective study was conducted to determine, if accurately implanted Bryan''s cervical disc prostheses can provide relief from objective neurological symptoms and signs, stability and normal range of motion in cases of cervical disc prolapse with myeloradiculopathy.

Material and Method

Twenty patients underwent Bryan cervical disc replacement from Jan 2002 to Dec 2003. Young patients between age groups 21 to 50 years with degenerative cervical disc prolapse at C3-C7 with myeloradiculopathy were included in this study. Patients with significant facet joint arthropathy, unstable spine, trauma, tumour, osteoporosis and active infection were excluded from this study. Nurick''s grading was used for quantifying the neurological deficit. Patients were operated by anterior cervical approach using a specially designed Bryan''s cervical discectomy system. Neurological and radiological outcome was assessed post operatively and at 2,6,12 and 24 months follow up. Outcome analysis was carried out using modified Odom''s criteria. The radiographic results were assessed by taking antero posterior (AP) and lateral radiographs of cervical spine to find range of motion and device position.

Results

The patients were in the age group of 31 to 50 years. There were 14 (70%) male and 6 (30%) female in this study. Neck pain and brachialgia were the presenting symptoms in all cases, 12 (60%) had radiculopathy and 8 (40%) had myelopathy. Single level disc prolapse was present as per Magnetic Resonance Imaging (MRI) in four (20%) at C4-C5, 12 (60%) at C5-C6 and 4 (20%) at C6-C7. Bryan''s disc size 15 was used in 8 (40%) and size 17 was used in 12(60%) patients. During post-operative, 02, 06, 12, and 24 months follow up, the clinical outcome was excellent in 16 (80%) and good in 4 (20%) as per modified Odom''s criteria. There was demonstrated improvement in flexion, extension and rotation clinically and radiologically during follow up. There was no migration or displacement of device.

Conclusion

Cervical disc replacement for cervical disc prolapse with myeloradiculopathy represents an exciting new technology. Patients treated with the Bryan cervical disc prosthesis for single level cervical disc prolapse showed good to excellent improvement in neurological deficit. Clinically and radiologically maintenance of motion was found during follow up. More patients with longer follow up and post operative MRI to find out the protection to adjacent discs from abnormal stress will be required before this prosthesis is accepted as a treatment option.Key Words: Spondylotic myeloradiculopathy, Cervical disc replacement     

颈椎人工间盘植入与融合固定后生物力学有限元比较分析

目的 研究颈椎人工间盘植入与前路融合内固定术后颈椎邻近节段的活动度、椎体及椎间盘内应力改变等生物力学分布的差异.方法 选取湖北医药学院附属东风医院脊柱外科采用两种手术方法治疗的单节段颈椎病患者,采用螺旋CT扫描分别获取在前屈、后伸、侧屈及旋转几种状态下的颈椎椎体、椎间盘、韧带断层图像,在Mimics软件中重建三维结构,然后导入Ansys10.0软件分别建立有限元模型.并求解计算,分析术后患者的颈椎结构变化及椎体终板接口的位移变化和应力分布,比较研究载荷传导、生物力学分布及稳定性情况的差别.结果 人工颈椎椎间盘置换术后患者的邻近节段活动基本正常,融合术后患者邻近节段的活动丧失达65%~75%.人工颈椎间盘置换术后患者邻近节段椎体及椎间盘内应力变化较小,融合术后患者在受到压力时,邻近椎间盘内应力增加明显,内植物与终板接口处应力集中.结论 人工颈椎间盘置换对邻近节段的生物力学影响很小,并不影响颈椎的正常活动.     

颈椎人工椎间盘临床应用81例

目的评价应用颈椎人工椎间盘置换术治疗颈椎间盘突出症的临床疗效。方法采用ADR治疗颈椎间盘突出病例81例,所有植入的人工椎间盘均为Bryan型颈椎间盘假体。所有病例平均随访2年,采用电话、信件预约、门诊复查相结合的随访方式进行。随访内容：所有患者术前、术后均进行详细的JOA评分测定,并收集同期的颈椎正侧片。结果患者术前JOA评分平均8.5分,术后15.5分,平均改善88%,患者临床症状均消失,未见假体移位。结论应用Bryan型人工椎间盘置换术治疗颈椎间盘突出症临床疗效良好,远期疗效还有待于临床进一步观察。