人工颈椎间盘置换术后中期并发症的临床观察

目的:通过总结Bryan人工颈椎间盘置换术后3年的疗效及发现的异位骨化和假体融合情况,探讨其发生率及对策.方法:自2005年12月至2008年12月,对54例单节段症状明显的颈椎病患者(男34例,女20例,年龄39～69岁,平均50.5岁)施行Bryan人工颈椎间盘置换术,随访24～36个月,平均30个月.分别以JOA评分和Odom＇s评分,分析患者的症状和功能改善情况.每3个月定期复查颈椎正侧位片,观察异位骨化和假体融合情况.同时在术前和置换后24个月,摄置换节段前屈后伸位、左右侧屈位X线片,观察置换假体的稳定性,以及置换节段的活动度变化.结果:54例患者疼痛症状和神经功能均得到明显改善,术后24个月JOA评分平均改善率76.1%,置换节段的屈伸运动范围有明显改善.置换后异位骨化和假体融合发生率逐年递增,1年3.7%(2/54),2年16.7%(9/54),最后随访时达22.2%(12/54).结论:人工颈椎间盘置换术后中期疗效优于传统术式.术后异位骨化和融合发生率较高,改良术式、早期功能锻炼可以降低发生率.

Clinical observation of mid-stage complications after cervical disc replacement

Objective: To summarize the therapeutic experience of Bryan prosthetic cervical disc replacement at the 3rd years after operation and to analyze the clinical effect,incidence rate of heterotopic ossification,conditions of prosthetic fusion in order to investigate the countermeasures. Methods: From December 2005 to December 2008,54 patients with cervical syndrome (34 males and 20 females,the age was from 39 to 69 years with an average of 50.5) were treated with single level Bryan prosthetic cervical disc replacement. The patients were followed for 24-36 months with an average of 30 months. The symptoms and nerve function were evaluated according to JOA and Odom's scoring. The anterior-posterior and lateral cervical X-ray films were also taken regularly every three months for the observation of heterotopic ossification and prosthetic fusion. Meanwhile,the X-ray films of the forward bending,extending,left and right lateriflection were taken before operation and at the 1st years after operation for the measurement of the stability and rang(ROM) of replaced levels. Results: The pain symptom and neurological function of all 54 patients were improved obviously. JOA score increased with an average of 76.1%,and ROM of replaced levels also improved obviously. The incidence rate of heterotopic ossification and prosthetic fusion went up year by year,3.7%(2/54) for the first year,16.7%(9/54) for the second year and 22.2%(12/54) for the nearly third year. Conclusion: Bryan prosthetic cervical disc replacement has better mid-stage results than conventional methods. Modified surgical methods and early rehabilitation exercise may reduce the relatively high incidence rate of heterotopic ossification and prosthetic fusion.