Bryan人工颈椎间盘置换治疗脊髓型颈椎病8例

回顾性分析2007-05/2008-07南通大学第二附属医院脊柱外科和上海长征医院骨科收治的脊髓型颈椎病患者8例，男2例，女6例；年龄36~58岁，病程8~24个月；病变节段：均为单节段，C4~5 5例，C5~6 3例。全部患者均采用Bryan人工颈椎间盘置换，置换后3个月行JOA评分，摄置换节段前屈后伸位、左右侧屈位X射线平片，观察假体置入后的稳定性及置换颈椎节段的活动度。结果显示置换过程中和置换后未出现神经和血管损伤的并发症，平均置换时间135 min。8例患者均进行门诊随访，随访时间3~13个月，所有患者置换后症状明显缓解。JOA评分由置换前平均8.9分(6~12分)增加到置换后第3个月平均15.2分(12~17分)。置换后3个月置换节段前屈后伸活动范围平均5.3°(4.3°~6.1°)；左右侧屈活动范围分别为平均3.4°(2.8°~4.3°)和3.5°(2.9°~4.3°)。假体无偏移或下沉。末次随访未发现置换节段异位骨化、假体松动、下沉或颈椎生理曲度的改变。提示Bryan人工椎间盘置换治疗脊髓型颈椎病近期临床效果良好，能维持颈椎正常的活动范围和生理曲度。

Treatment of cervical spondylotic myelopathy with Bryan cervical disc prosthesis replacement in 8 cases

Eight cases of cervical spondylotic myelopathy were treated by Bryan cervical disc prosthesis replacement in the Second Affiliated Hospital of Nantong University and Shanghai Changzheng Hospital between May 2007 and July 2008 were selected, including 2 males and 6 females, with aged 36-58 years and course of disease 8-24 months. 5 cases had disc herniation at C4-5 segment and 3 cases at C5-6 segment. Clinical (JOA score) and radiological (X-ray of bending, extending, left and right bending positions) study were performed at 3 months after operation in all cases in order to investigate the stability of implanted prosthesis, and the range of motion of operative segment. No neurological or vascular complication was found during or after surgery, the average operative time was 135 minutes. The follow-up was performed during 3-13 months (average 6.8 months) in 8 cases, and the neurological deficit was alleviated in all cases. JOA score increased from the average of 8.7 (6-12, before operation) to 15.2 (12-17, 3 months after operation). The range of motion of operative segment was 5.3° (4.3°-6.1°) in flextion and extension position and 3.4° (2.8°-4.3°), 3.5° (2.9°-4.3°) in left and right bending position at 3 months after operation. There was no prosthesis subsidence or excursion. No ectopic ossifications of operative segment, prosthesis loosen or subsidence was found in the last follow-up. It suggests that the Bryan disc prosthesis can achieve good early clinical outcome in treating with cervical spondylotic myelopathy, maintain the normal range of motion and retain physiological curve of cervical spine.