人工椎间盘置换术治疗脊髓型颈椎病的临床疗效分析

目的探讨人工颈椎间盘置换术(CADR)与前路减压椎体融合术(ACDF)对比治疗单节段脊髓型颈椎病(CSM)的早中期临床疗效。方法 2015年1月至2018年1月,共完成随访单节段CSM患者40人,其中19人采用ACDF治疗,21人采用CADR治疗,两组患者分别观察记录术前、术后3个月、术后1年、术后3年的JOA评分与NDI评分,以及JOA评分改善率;检查MRI与X线影像变化,观察术后减压效果及内置物位置是否满意。结果两组患者术后的临床症状均得到明显缓解,神经功能得到显著改善,组内比较,术后各个时间段JOA评分、NDI评分与术前相比均有统计学差异(P0.05);组间比较,ACDF组与CADR组术后各时间段的JOA评分无明显差异(P0.05)、NDI评分CADR组术后各时间段均优于ACDF组(P0.05);ACDF组JOA评分优良率为84%,CADR组为90%,无明显统计学差异(P0.05)。影像学表现,末次随访ACDF组融合成功率为94.7%,CADR组2例发生轻度异位骨化,但人工椎间关节活动度无明显受限。两组均未发生严重的术后并发症。结论通过与经典前路融合术式的疗效对比,人工颈椎间盘置换术不仅能获得同样优良的减压效果,还能利用仿生假体维持原有的椎间活动能力,有效避免因融合导致的周围骨关节代偿功能增加而发生的退变,取得满意的近期疗效。

Clinical analysis of cervical artificial disc replacement for cervical spondylotic myelopathy

【Abstract】 Objective To explore the clinical efficacy of cervical artificial disc replacement （CADR）and nterior cervical decompression and fusion（ACDF）in the treatment of single?segment cervical spondylotic myelopathy（CSM）. Methods From January 2015 to January 2018, 40 patients with single?segment CSM were enrolled, 19 of whom were treated with ACDF（ACDF group）and 21 with CADR （CADR group）. The patients in two groups were observed and followed before the surgery and 3 months, one year, 3 years after surgery. The JOA score, NDI score and the improvement rate of JOA score was recorded. The changes of MRI and X?ray images were examined. The effect of cervical decompression and fusion and the implant were observed and recorded. Results The clinical symptoms of the two groups were significantly relieved, and the neurological function was significantly improved. The JOA score and NDI score were statistically different between the two groups（P<0.05）. There was no significant difference in JOA scores between the ACDF group and the CADR group（P>0.05）, and the NDI scores in the CADR group were superior to the ACDF group（P<0.05）. The ACDF group had excellent JOA scores. The rate was 84%, and the CADR group was 90%. There was no statistically significant difference（P>0.05）. In the imaging findings, the success rate of fusion in the ACDF group was 94.7% at the last follow?up, and mild heterotopic ossification occurred in 2 patients in the CADR group, but the artificial intervertebral joint mobility was not significantly restricted. No serious postoperative complications occurred in either group. Conclusion Compared with the classic anterior fusion method, cervical artificial disc replacement can not only obtain the same excellent decompression effect, but also use the bionic prosthesis to maintain the original intervertebral activity, effectively avoiding the degeneration caused by peripheral bone joint compensation function increase because of fusion and a satisfactory short?term effect is obtained.