Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访

背景：Bryan人工颈椎间盘置换的短期疗效优良已被大多数学者公认，但有关其中长期临床效果及并发症的资料较少。 目的：总结Bryan人工颈椎间盘置换治疗颈椎病的中期临床效果。 方法：选择2004-11/2007-12在四川大学华西医院骨科接受Bryan人工颈椎间盘置换的颈椎间盘突出症患者34例，其中单节段置换30例，双节段置换4例。于置换前、置换后7 d、3，6，12，24，36，48个月行SF-36生活质量量表评分、JOA评分、颈部及上肢疼痛目测类比评分；以颈椎正侧位及功能位X射线片测量手术节段、邻近节段及C2~7屈伸活动度的变化，手术节段和邻近节段椎间高度变化及手术节段的轴向平移情况。 结果与结论：所有患者置换后神经症状均明显好转，各随访点SF-36生活质量量表躯体评分和心理评分、JOA评分、颈部和上肢疼痛目测类比评分较置换前明显改善(P < 0.05)，3个月之后各随访时点两两比较差异无显著性意义(P  > 0.05)。置入的Bryan假体历次随访均保留了>2°的活动度，未发现手术节段异位骨化与自发性融合，随访48个月时手术节段及C2~7屈伸活动度较置换前略有增加，但差异无显著性意义(P > 0.05)；上下邻近节段屈伸活动度维持了置换前水平；手术节段的椎间高度由置换前的(6.04±1.02) mm增加到(8.44±0.43) mm(P  < 0.05)；上下邻近节段椎间高度及手术节段的轴向平移均维持了置换前水平。说明Bryan人工颈椎间盘治疗颈椎间盘退变性疾病的中期临床效果良好，较好的保留了手术节段、邻近节段及整个颈椎的运动学特性，且近中期并发症很少。

Clinical outcome of Bryan artificial cervical disc replacement for the treatment of cervical spondylosis: A midterm follow-up

BACKGROUND:Although the short-term clinical efficacy of Bryan artificial cervical disc replacement is generally acknowledged by most spinal surgeons, the midterm and long term clinical results and complications are still unclear. OBJECTIVE:To summarize midterm term clinical results of Bryan artificial cervical disc replacement for the treatment of cervical spondylosis. METHOD:From November 2004 to December 2007, 34 patients had Bryan cervical disc replacement in Department of Orthopedics, West China Hospital were selected, including 30 cases with single replacement and 4 cases with bi-level replacement. Clinical result was evaluated by SF-36 score, JOA score, and neck/arm pain VAS scores. And the data was collected before surgery and at 7 days, 3, 6, 12, 24, 36 and 48 months after surgery. Neutral lateral and dynamic cervical radiographs were made to measure the flexion-extension range of motion (ROM) of operative segment, adjacent segments and C2-7 segment, the intervertebral height of operative and adjacent segments, and the translation of operative level. The intraoperative and postoperative complications were recorded and analyzed. RESULTS AND CONCLUSION:The neurological symptoms of each patient were alleviated notably. The postoperative SF-36 physical component score and SF-36 mental component score, JOA score, NDI score and neck/arm pain VAS scores were significantly improved compared with those of the preoperative (P  < 0.05), but no statistical significance were noted between each time point after 3-month follow-up (P  > 0.05). Each implanted prosthesis preserved the ROM>2° at each follow-up time point, and no heterotopic ossification or spontaneous fusion was found at the operative segment. At 48-month follow-up, flexion-extension ROM of operative segment and C2-7 segment slightly increased but showed no statistical significance compared with the preoperative counterparts (P > 0.05); ROM of upper and lower adjacent segments also showed no statistical significance compared with the preoperative data (P > 0.05). Intervertebral height of operative segment was (6.04±1.02) mm before the operation and significantly increased to (8.44±0.43) mm at 48-month follow-up (P  < 0.05). Intervertebral height of adjacent segments, and the translation of operative level were not significantly changed (P  > 0.05). The clinical result of Bryan artificial cervical disc replacement is good and kinematic characteristics of operative segment, adjacent segments and C2-7 segment can be maintained in midterm follow-up. The operation is safe and there are few early midterm complications.