人工颈椎间盘置换术后早中期临床疗效及并发症评价

目的 观察采用Bryan人工颈椎间盘置换治疗颈椎间盘突出症术后2-5年并发症的发生情况及临床疗效.方法 回顾分析45例颈椎间盘突出症患者,年龄31～59岁,平均46岁.临床症状以脊髓压迫为主者19例,神经根性症状为主者26例.单节段置换39例,双节段置换6例,共置人51个Bryan椎间盘假体.术后定期随访,摄颈椎动态X线片,部分患者完成MRI检查.观察置入假体位移、假体周围骨吸收、异位骨化、假体活动度及颈椎生理曲度变化.依照JOA评分(17分)和Odom标准评定神经功能改善,采用NDI(颈椎残障功能量表)评定术后临床症状改善和日常功能状态.结果 本组45例共置换51个节段.术后随访无一例假体前后位移大于2 mm,假体与椎体上、下终板无X线透光线存在,3例在置换节段上位椎体前下缘有轻微骨吸收,1例该处吸收接近2.5mm,1例随访出现自发性融合,1例置换节段发生Ⅲ度异位骨化,2例置换节段发生Ⅱ度异位骨化.术后置换假体活动度平均为9.1°,颈椎生理曲度有明显改善或恢复正常.患者神经功能有明显改善,以神经根性症状为主的患者上肢根性痛全部缓解.JOA评分由术前10.1分增加到终末随访时的15.2分.NDI评分从术前的42.5分降低到终末随访的29.5分,Odom评分临床成功率达到88.9%.结论 人工颈椎间盘置换术后早中期并发症少,具有良好的稳定性和活动度,术后神经功能恢复良好,但应设计更加完善的假体型号,以更好地适应国人的解剖参数.

Intermediate Clinical Result and Complications of Artificial Cervical Disc Replacement

Objective To evaluate the 2 to 5 years' postoperatively clinical results and complications of cervical disc herniation treatment with the Bryan cervical disc prosthesis.Methods There were 45 patients with cervical disc herniation.There were 19 patients with myelopathy and 26 with radiculopathy.A total of 51 sets of Bryan cervical disc prosthesis were implanted with single level disc replaced in 39 patients and bi-level in 6.The follow-up was 2 to 5 years.The clinical symptom and the neurological function we...