双节段颈椎间盘置换联合cage融合术治疗颈椎病

目的观察连续双节段Bryan人工颈椎间盘置换联合邻近节段cage融合术治疗三节段颈椎病的临床疗效,探讨该联合术式(Hybrid术式)的可行性及节段选择标准。方法采用双节段Bryan人工颈椎间盘置换联合邻近节段cage融合术治疗58例连续三节段病变的颈椎病患者。术前、术后进行JOA评分(17分法)和颈椎残障功能量表(NDI)评定;术后进行Odom标准评定;随访观察椎间盘假体稳定性、假体活动度、cage融合状态及cage位移情况等。结果手术均顺利完成,未出现严重术中不良事件,手术时间60~125(88.3±10.5)min;术中出血量10~60(30.3±12.1)ml。58例均获随访,时间6~48(22.2±8.3)个月。末次随访时,JOA评分由术前5~10(8.6±1.2)分增至12~17(14.1±1.5)分(P0.01);NDI评分由术前34~42(40.5±2.6)分降至13~20(16.8±3.3)分(P0.01)。Odom评定:优36例,良12例,可6例,差4例,优良率为93.1%。人工椎间盘稳定,置换节段活动度为16°~21°(18.2°±5.6°),与术前17°~23°(19.1°±4.8°)比较差异无统计学意义(P0.05),术后颈椎整体活动度为26°~41°(33.8°±10.3°),与术前33°~52°(40.3°±12.6°)比较差异无统计学意义(P0.05)。Cage植骨全部融合,无cage松动和沉陷。结论连续双节段颈椎间盘置换联合邻近节段cage融合为三节段颈椎病患者的手术治疗提供了新的术式选择,兼顾了颈椎的稳定和运动功能,初、中期随访疗效让人满意。

Clinical study of a cervical anterior hybrid technique with Bi-level Bryan artificial disc re-placement and nearby segment fusion for cervical myelopathy

Objective To explore the clinical effects of a cervical anterior hybrid technique with Bi-level Bryan artifi- cial disc replacement and nearby segment fusion for three consecutive segments cervical myelopathy, and to discuss the feasibility and segment selection criteria of the hybrid surgery. Methods 58 cases were treated with the hybrid surgery method. The clinical symptom and neurological function before and after surgery were evaluated according the JOA score （17 points） ,neck disability index（NDI） and Odom＇s criteria. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed postoperatively. Results All operations were successfully completed, and no intraoperative and postoperative complication was noted. The operating time was 60 - 125 （88.3 ± 10. 5） min. The volume of blood loose was 10 ～ 60 （30. 3 ± 12. 1 ） ml. 58 cases were followed up for 6 -48 （22. 2 ±8. 3） months. At final follow up,the JOA score was 12 - 17（ 14. 1± 1.5） compared with 5 ～ 10 （ 8. 6 ± 1.2） of preoperation （P 〈 0. 01 ）, and the N DI was 13 ～ 20 （ 16. 8 ± 3.3 ） compared with 34 ～ 42 （40. 5 ± 2. 6） of preoperation （ P 〈 0. 01 ） , the Odom＇s criteria was rated as excellent in 36 cases, good in 12 cases, fair in 6 cases and poor in 4 cases, and the excellent-good rate was 93.1%. All Bryan disc achieved definite stabilization. The range of motion for arthroplasty level was 16° -21°（ 18. 2 ± 5.6°） of flexion-extension, it wasn＇t satistically significant for comparing with 17 °- 23 ° （ 19. 1° ~ 4. 8 ° ） of preoperation （ P 〉 0. 05 ）, and the C2 - 7 range of motion was 26° -41°（33.8° ± 10. 3°） compared with 33° ～ 52 （40. 3° ± 12. 6°）, the difference hadn＇t significance （P 〉 0. 05 ）. Solid fusion was achieved in all levels brought by cage. There was no cage subsidence or displacement. Condusions The cervical anterior hybrid technique with Bi-level Bryan artificia