Bryan颈人工椎间盘置换术失败原因分析

目的 对Bryan颈人工椎间盘置换术治疗颈椎病的失败原因进行分析.方法 2004年10月至2007年10月,采用Bryan颈人工椎间盘对48例颈椎病患者的56个椎间盘进行治疗,其中单节段40例,双节段8例.术后随访2～38个月,平均18个月.手术失败4例,男1例,女3例;年龄分别为42、51、40、49岁.患者均为经6周的保守治疗无效后行Bryan颈人工椎间盘置换.结果 1例全麻后在用胶带固定患者体位的过程中造成对臂丛的过度牵拉,术后双上肢肌力下降到2～3级.1例术前CT及MRI显示C4～C6水平后纵韧带骨化,其中C4,5节段骨桥形成,向后方压迫脊髓;手术切除部分骨化后纵韧带,使之漂浮;术后患者症状无改善,并出现锥体束征阳性,复查CT及MRI示存在骨化后纵韧带压迫脊髓.1例术前MRI显示C4-5椎间盘突出,椎管前后径约为5 mm,C4,5水平脊髓变性;术中向外侧减压时致椎管内静脉破裂,出血影响术野;术后左侧肢体肌力下降至0级.1例术后1年发现假体后方异位骨化,但不影响关节活动.结论 臂丛损伤、减压不彻底、术中椎管内静脉出血和异位骨化可能是引起颈椎人工椎间盘置换术失败的主要原因.

Analysis of failed Bryan cervical disc arthroplasty

Objective To analyze the failed Bryan cervical disc arthroplasty and to improve its re-sults. Methods From October 2004 to October 2007, 48 patients underwent Bryan cervical disc arthro-plasty. All patients were followed up 2 to 38 months(mean 18 months). Among them, 4 failed cases were an-alyzed, which include 1 male and 3 females, with the age of 42, 51, 40, 49 years. Results Case 1 reported the brachial plexus injury as the result of the patient's shoulders being overstretched while fixing his position during operation, the muscular power of both upper extremities declining to degree Ⅱ and Ⅲ upon operation completion, which was restored to degree 4 when discharged from hospital (45 days after operation). Case 2 reported the compression on the spinal cord as the result of failure to remove the ossification of posterior lon-gitudinal ligament (OPLL) which had been identified by the preoperative CT; the patient complained of no release of symptoms after the operation and postoperative CT showed that compression still existed. Case 3 reported incomplete spinal cord injury caused by massive bleeding during decompression, a function of ex-tremely small vertebral canal anteroposterior diameter (5 mm shown in preoperative MRI); the muscular pow-er of left extremity dropped to degree 0 upon operation completion; the patient could walk with crutch 10 days after operation. Case 4 reported'heterotopic ossification (OP) which occurred 1 year after operation and became deteriorated 2 years later, but did not affect the motion of prosthesis. Conclusion Bryan disc arthroplasty is being extensively used as an effective procedure for decompression and reconstruction of the cervical disc. Excellent clinical results are related to strict selection of indications, perioperative manage-ment, and the experience and surgical technique of the surgeon are also important to the final outcome.