Bryan人工颈椎间盘置换与椎间融合治疗颈椎病的中期疗效比较

背景：国内外有许多相关报道颈人工椎间盘置换治疗颈椎病取得了非常好的近期临床疗效，但因其刚刚开展不久，缺乏长期随访结果。 目的：观察Bryan人工颈椎间盘置换治疗颈椎病的临床和影像学结果及邻近节段活动度的情况，并与椎间融合治疗方法比较。 设计、时间及地点：回顾性病例分析，于2004-10/2006-04在河北医科大学第三医院脊柱外科完成。 对象和方法：22例患者行Bryan假体置换（置换组），同期行常规颈前路椎间盘切除减压植骨融合内固定患者30例（融合组）。在术后1周、3个月、6个月、12个月、24个月进行随访，在每一次随访中拍摄颈椎前屈后伸位、左右侧屈位X射线片，观察置换组假体稳定性及融合组融合节段骨性融合情况。 主要观察指标：①材料与宿主的生物相容性。②临床疗效评估。 结果：全部病例随访最短24个月，平均30.6个月。①融合组患者术后6个月植骨全部骨性融合；内固定无松动、脱落、断裂的发生。置换组患者置换后无假体移位、脱落等并发症发生。②两组患者随访时神经功能均得到明显恢复，两组JOA评分差异无显著性意义（P > 0.05）。③置换组1例患者随访2年发生椎间自发融合，置换节段活动丢失；其余21例患者置换节段活动度与置换前差异无显著性意义（P > 0.05）。④融合组术后邻近节段的活动度较术前明显增大（P < 0.05）；而置换组置换前后邻近节段活动范围差异无显著性意义（P > 0.05）。 结论：与前路融合方法比较，中期随访结果显示Bryan人工颈椎间盘置换治疗颈椎病在取得满意临床疗效的同时能保留置换节段的活动，且避免了置换后上下邻近节段活动度的增加。

Mid-term curative effects of Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for cervical syndrome

BACKGROUND: Artificial cervical disc arthroplasty has achieved favorable short-term clinical efficacy. However, long-term follow-up results are rarely reported. OBJECTIVE: To study the clinical and radiological outcome of Bryan cervical disc arthroplasty and the range of motion status on adjacent segments, and compare with anterior cervical discectomy and fusion. DESIGN, TIME AND SETTING: A retrospective case analysis. The experiment was performed at the Department of Spinal Surgery, the Third Hospital of Hebei Medical University from October 2004 to April 2006. PARTICIPANTS AND METHODS: Twenty-two patients underwent Bryan cervical disc replacement (Bryan group), and 30 patients underwent traditional anterior cervical discectomy and fusion (ACDF group). At 1 weak, 3, 6, 12, and 24 months after operation, the patients were followed up. The radiography of forward flexion, backward extension, and left and right lateral flexion was obtained at every follow-up time. The stability of prosthesis, the range of motion status at operated level in Bryan group and the fusion in ACDF group were observed. MAIN OUTCOME MEASURES: Biocompatibility between materials and host; evaluation of clinical curative effect. RESULTS: The patients were followed up for at least 24 months (average 30.6 months). All patients achieved bone fusion six months after operation without internal fixation loosening, dislocation or breakage in ACDF group. No complications such as prosthesis dislocation or loosening occurred in Bryan group. The neurological function was significantly improved during follow-up, and JOA scores showed no significant differences (P > 0.05). In Bryan group, one case developed spontaneous fusion 2 years postoperatively, and the motion at operated level of the rest cases were preserved (P > 0.05). The range of motion postoperative on adjacent segments was increased obviously than preoperative in ACDF group (P < 0.05), but there were no significant differences in Bryan group before and after replacement (P > 0.05). CONCLUSION: Compared with traditional anterior cervical discectomy and fusion, Byran disc arthroplasty for cervical syndrome exhibits good mid-term outcomes. Moreover, the motion at operated level is preserved and the increase of range of motion on adjacent segments postoperative is avoided.