Prestige-LP人工椎间盘置换术治疗跳跃型颈椎椎间盘突出症

目的评价Prestige-LP人工椎间盘置换术治疗跳跃型颈椎椎间盘突出症的疗效。方法回顾分析2008年1月—2015年2月在本院接受人工椎间盘置换术治疗的29例跳跃型颈椎椎间盘突出症患者的临床资料。对所有患者均于术前、术后1周、术后3个月、术后6个月、术后12个月及末次随访时,采用生活质量量表(SF-36)评分、颈部疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)评估临床效果;采用颈椎正侧位及功能位X线片测量颈椎曲度,跳跃节段椎间角度、置换节段、跳跃节段的屈伸活动度(ROM)和椎间高度,以及C2~7屈伸ROM。结果所有患者随访6~82个月,平均25.1个月。所有患者的神经症状均明显好转,术后各随访时间点SF-36、JOA评分、VAS评分、NDI均较术前明显改善,差异具有统计学意义(P0.05)。术后3个月,跳跃节段屈伸ROM由术前的12.72°±3.80°增加到16.04°±3.17°(P0.05),后逐渐减小,至末次随访时接近术前水平。术后上、下置换节段的椎间高度较术前明显增加(P0.05)。所有患者末次随访时颈椎曲度、跳跃节段椎间角度、置换节段及C2~7 ROM与术前相比差异无统计学意义(P0.05)。结论 Prestige-LP人工椎间盘置换术治疗跳跃型颈椎椎间盘突出症能较好地保留置换节段、跳跃节段及颈椎整体的运动学特性,且术后并发症少,是一种安全有效的治疗选择。

Clinical and radiographic outcomes of artificial cervical disc replacement with Prestige-LP for treatment of skip-level cervical spondylosis

Objective To evaluate the short-to mid-term outcomes of Prestige-LP artificial cervical disc replacement (ACDR) for the treatment of skip-level cervical disc herniation. Methods From January 2008 to February 2015,the clinical data of 29 patients who received ACDR with Prestige-LP in Department of Orthopedics of West China Hospital were reviewed. Short form-36(SF-36) score,Japanese Orthopedic Association(JOA) score,visual analogue scale(VAS) score and neck disability index(NDI) were adopted for assessing the clinical effects before surgery,at 1 week,3,6 and 12 months and the final follow-up after surgery. Static and dynamic radiographs were used to measure overall cervical alignment,disc angle of skip-level,range of motion(ROM) of the operated and intermediate segments and C_2-7,and the disc height(DH) of the operated and intermediate segments. Results All patients were followed up for 6-82 months(mean 25.1 months). The neurological symptoms of all the patients were relieved obviously. The postoperative SF-36,VAS,JOA scores and NDI significantly improved compared with the preoperative values(P<0.05). At 3-month follow-up,the ROM of the skipped level increased from 12.72°±3.80° to 16.04°±3.17°(P<0.05). After 3-month follow-up,ROM of the skipped level decreased gradually,but was higher than that before surgery. The DHs of both the upper and lower operated segments increased compared with those before surgery,respectively(P<0.05). At the final follow-up,the disc angle of skip-level,ROMs of the operated segments and C_2-7 had no statistical significances compared with those before surgery(P>0.05). Conclusion The outcomes of Prestige-LP ACDR for the treatment of skip-level cervical disc herniation are satisfactory,and the kinematic characteristics of operated segments,skip-level and overall cervical spine can be maintained in the short-to mid-term follow-up. According to the results,the Prestige-LP ACDR may be a safe and effective alternative to fusion for skip-level cervical disc herniation.