人工椎间盘置换术治疗跳跃型多节段颈椎病的中期疗效

 目的 评价 Bryan 人工间盘置换术治疗跳跃型多节段颈椎病的疗效。方法 回顾性分析 2002 年 2 月至 2012 年 5 月接受 Bryan 间盘置换术（Bryan 组）或颈前路减压植骨融合术（ACDF 组）治疗的跳跃型多节段颈椎病患者相关资料。临床功能评估采用日本矫形外科协会（Japanese orthopaedic association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、疼痛视觉模拟评分（visual analoguc scale,VAS），影像学评估采用颈椎矢状位曲度、颈椎整体活动度及中间节段活动度，并于末次随访时评估邻近节段退变情况。结果 49 例患者随访超过 24 个月，Bryan 组 18 例，ACDF 组 31 例。两组患者性别、年龄、疾病类型等人口学资料的差异无统计学意义。两组患者术后 JOA、NDI、VAS 评分均较术前有明显改善。两组间各时间节点比较仅末次随访时 VAS 评分的差异有统计学意义。Bryan 组术后轴性症状发生率、颈椎活动度和未手术节段活动度分别为 11.1%、35.5°±5.9°和 7.3°±1.4°，ACDF 组分别为 45.2%、24.5°±6.2°、10.1°±1.6°，差异均有统计学意义。Bryan 组患者邻近节段无明显退变，ACDF 组 2 例出现退变，但无需再次手术。结论 应用 Bryan 间盘置换术治疗跳跃型多节段颈椎病，可有效改善神经功能，保留颈椎整体活动度，减少未手术节段活动度的代偿性增加，从而降低邻近节段退变及轴性症状发生率。

Comparison of the mid-term follow-up results between treatment of Bryan cervical artificial disc replacement and anterior cervical decompression and fusion for "skip" cervical spondylosis

Objective To retrospectively analysis and compareabout Bryan artificial cervical disc arthroplasty with anterior cervical decompression and fusion (ACDF) on the clinical efficacy for“Skip”cervical spondylosis. Methods From February 2002 to May 2012, 49 cases were treated with Bryan artificial cervical disc arthroplasty (artificial cervical disc replacement surgery group, 18 cases) or anterior cervical decompression and fusion (ACDF group, 31 cases), 29 males and 20 females. Each case was evaluated at the moment of preoperatively, 3 months, 6 and 12 months and last follow-up after surgery by the Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Visual Analog Scale (VAS), Cervical sagittal curvature, the total cervical spine range of motion（ROM），middle segments of motion. MRI was also used to assess to adjacent segment disc degeneration, spinal cord compression and signal change situation. Results All patients were followed up for more than 24 months. The score of the JOA, NDI, VAS in the two groups of patients improved significantly after surgery than before surgery. In addition, the VAS score in last follow-up were significantly different between the two groups, but other index each time in the two groups showed no significant difference. In last follow-up, the result of artificial cervical disc arthroplasty group were better than ACDF group on the incidence of axial symptoms, the total cervical spine range of motion (ROM) and middle segments of motion. The incidence of axial symptoms in artificial cervical disc arthroplasty group were 11.1%，ACDF group were 45.2%. ROM in artificial cervical disc arthroplasty group were 35.5°±5.9°，ACDF group were 24.5°±6.2°. Middle segments of motion in artificial cervical disc arthroplasty group were 7.3°±1.4°，ACDF group were 10.1°±1.6°. The above comparison of the datas were statistically different. There are two cases of adjacent segment degeneration in ACDF group without need to surgery. Conclusion Bryan artificial cervical disc replacement surgery effectively retained the overall motion of the cervical spine, reduced the motion of middle segments, thus avoiding adjacent segment degeneration and the incidence of postoperative axial symptoms.