人工颈椎间盘置换术后邻近节段退变情况的早中期随访

目的研究人工颈椎间盘置换术治疗颈椎病的临床疗效及邻近节段退变情况。方法 2008年1月-2010年10月,采用人工颈椎间盘置换术治疗颈椎病患者39例。其中男20例,女19例;年龄32～60岁,平均45.7岁。病程1个月～10年,平均30个月。其中脊髓型颈椎病26例,神经根型颈椎病11例,混合型颈椎病2例(神经根型加脊髓型)。单节段病变27例,双节段病变12例。使用Prestige假体9例、Prodisc-C假体4例、Discover假体26例。采用日本骨科协会(JOA)评分评价患者神经功能恢复情况,测量置换节段及邻近节段活动度(Cobb角变化),并采用Kellgren X线颈椎退变分级评估法对邻近节段颈椎间盘退变情况进行评价。结果所有患者均顺利完成手术,术后切口均Ⅰ期愈合。39例均获随访,随访时间12～36个月,平均23.1个月。末次随访时患者JOA评分较术前显著提高(P<0.05),置换节段及置换节段相邻上、下位节段活动度与术前比较差异均无统计学意义(P>0.05)。根据Kellgren X线椎间盘退变分级评价结果显示,末次随访时有5例患者出现退变情况改变,其中从无(0级)退变为轻度(1、2级)3例,由轻度1级退变到轻度2级1例,由轻度2级退变到中度(3级)1例,退变发生率为12.8%,但退变情况分级与术前比较差异无统计学意义(χ2=1.793,P=0.406)。术后15个月(32例患者)邻近椎间盘未发生退变情况。结论人工颈椎间盘置换术治疗颈椎病有良好疗效,可较好地保留置换节段及邻近节段活动度,并可能对邻近节段的椎间盘起保护作用。

Adjacent segment degeneration after cervical artificial disc replacement at early mid-term follow-up

Objective To study the effectiveness of artificial disc replacement for cervical diseases and the adjacent segment degeneration.Methods Between January 2008 and October 2010,39 cases of cervical spondylosis underwent cervical disc replacement.Of them,there were 20 males and 19 females with an average age of 45.7 years(range,32-60 years) and an average disease duration of 30 months(range,1 month to 10 years),including 26 cases of cervical myelopathy,11 cases of nerve root cervical spondylosis,and 2 cases of mixed cervical spondylosis.Single level disc lesion was observed in 27 cases while bi-level lesion in 12 cases.Prestige disc prosthesis was used in 9 patients,Prodisc-C prosthesis in 4 patients,and Discover disc prosthesis in 26 patients.The neurological functional recovery was assessed after operation by Japanese Orthopaedic Association(JOA) score.The range of motion of replaced segment and adjacent segments was measured(Cobb angle),and Kellgren’s X-ray assessment was used to evaluate the degree of adjacent segment degeneration.Results The operation was successfully performed in all cases,with primary healing of all the incisions.All patients were followed up from 12 to 36 months with an average of 23.1 months.JOA score was significantly improved at last follow-up when compared with preoperative score(P < 0.05),and no significant difference was observed in the Cobb angle of replaced segment and adjacent segments between pre-and postoperation(P > 0.05).According to the Kellgren’s X-ray assessment,degeneration of the adjacent segments occurred in 5 cases at last follow-up,including 3 cases of degeneration from grade 0 to grade 1 or 2,1 from grade 1 to grade 2,and 1 from grade 2 to grade 3,with a degeneration rate of 12.8%,but no significant difference was found in degeneration degree when compared with preoperative value(χ2=1.793,P=0.406).No degeneration of adjacent segments occurred in 32 patients at 15 months after operation.Conclusion Artificial disc replacement has a good effectiveness in treating cervical spondylosis,which can maintain the range of motion of the replaced segment and adjacent segments,and may have a protective effect on adjacent segment discs.