Discover人工颈椎间盘置换治疗颈椎病的初步应用

目的通过与颈前路减压植骨内固定术治疗患者比较,探讨应用Discover人工颈椎间盘置换治疗颈椎病的早期效果。方法回顾分析2010年3月-2011年3月24例符合选择标准的神经根型和脊髓型颈椎病患者临床资料,按收治时间分为颈前路减压融合组(融合组13例,2010年3月-2010年9月)和Discover人工颈椎间盘置换组(置换组11例,2010年9月-2011年3月)。两组患者性别、年龄、病程、病变分型、病变节段等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录手术时间、出血量、术后并发症,采用日本骨科协会(JOA)改善率、颈椎功能障碍指数(NDI)、Odom’s评分评价疗效;置换组于手术前后X线片上测量置换及其邻近节段的过伸过屈、左右侧屈活动度,以及假体偏心距。结果两组患者术后症状均缓解,未出现明显并发症。患者均获随访,融合组随访时间12～18个月,平均15.3个月;置换组随访时间6～12个月,平均9.6个月。术后1、3、6个月置换组NDI均高于融合组(P<0.05),但JOA评分改善率比较差异无统计学意义(P>0.05)。末次随访时融合组Odom’s评分为优6例,良4例,可3例,优良率76.92%;置换组为优9例,良1例,差1例,优良率90.91%;两组比较差异无统计学意义(χ2=3.000,P=0.223)。术后置换组过伸过屈及右侧屈活动度于1个月时明显减小(P<0.05),之后逐渐恢复;左侧屈活动度呈先增加后减少趋势,其中3、6个月时较术前明显增加(P<0.05)。术后置换节段和上位节段左侧屈活动度大于右侧屈(P<0.05),且上位节段左、右侧屈活动度差约为置换节段的2倍;侧屈活动度差与假体偏心距成正相关(P<0.05),且假体偏向侧的侧屈活动度增大,对侧活动度减小。结论 Discover人工颈椎间盘置换术是一种简便、安全且能保留颈椎活动的手术,早期疗效较好。

Early effectiveness of discover cervical artificial disc replacement in treatment of cervical spondylosis

Objective To investigate the early effectiveness of the Discover cervical artificial disc replacement in treating cervical spondylosis.Methods Qualified for the selective standard,24 patients with cervical spondylosis were treated between March 2010 and March 2011.Of 24 patients,13 patients underwent anterior cervical decompression and fusion(ACDF)(ACDF group,between March 2010 and September 2010) and 11 patients underwent Discover cervical artificial disc replacement(CADR group,between September 2010 and March 2011).There was no significant difference in gender,age,disease duration,lesions typing,and affected segments between 2 groups(P > 0.05).The operative time,blood loss,and complications were recorded.Japanese Orthopaedic Association(JOA) scores,Neck Disability Index(NDI) scores,and Odom’s scores were used to evaluate the postoperative effectiveness.In CADR group,the cervical range of motion(ROM) in all directions,and prosthesis eccentricity were measured before and after operation.Results Symptoms disappeared and no complication occurred after operation in the patients of 2 groups.The patients were followed up 12 to 18 months(mean,15.3 months) in ACDF group and 6 to 12 months(mean,9.6 months) in CADR group.The NDI scores in CADR group were significantly higher than those in ACDF group at 1,3,and 6 months(P < 0.05),but no significant difference was observed in JOA score improvement rate between 2 groups(P > 0.05).According to Odom’s score at last follow-up,the results were excellent in 6 cases,good in 4 cases,and fair in 3 cases with an excellent and good rate of 76.92% in ACDF group,and were excellent in 9 cases,good in 1 case,and poor in 1 case with an excellent and good rate of 90.91% in CADR group,showing no significant difference(χ2=3.000,P=0.223).The patients in CADR group had significant limit of cervical joint ROM in flexion and extension and right bending at 1 month(P < 0.05),but cervical joint ROM restored after 3 months.The ROMs of left bending at 3 months and 6 months were bigger than preoperative value(P < 0.05).Meanwhile,ROM in left bending were bigger than that in right bending in replaced segment and upper segment(P < 0.05),and the ROM difference between left bending and right bending in upper segment was 2 times higher than that in the replaced segment;a marked linear correlation(P < 0.05) existed between the ROM difference and prosthesis eccentricity,and prosthesis bias had bigger ROM in lateral bending.Conclusion Discover cervical artificial disc replacement for treatment of cervical spondylosis can provide a good effectiveness and cervical postoperative movement function.As a new prosthesis,it has some merits such as simple operative steps and less complications.