人工颈椎间盘置换的疗效及其对相邻非责任节段失稳的影响

The outcome and influence of artificial cervical disc replacement on adjacent non-responsible segment instability in patients with cervical spondylosis

中文关键词:  颈椎病  椎间盘置换术  相邻节段  失稳

英文关键词:Cervical spondylosis  Cervical disc replacement  Adjacent segement  Instability

中文摘要:

  【摘要】 目的：观察相邻非责任节段失稳颈椎病患者Bryan人工颈椎间盘置换术后的临床疗效及失稳节段的影像学变化。方法：2005年7月～2009年1月在我院行Bryan人工颈椎间盘置换术且术后随访36个月以上的43例颈椎病患者中，9例术前存在置换相邻节段失稳，男4例，女5例；年龄26～43岁，平均33.5岁。术前JOA评分为7～13（10.16±3.17）分，颈痛VAS为1～7（4.3±2.7）分。术前均经颈椎正侧位与屈伸动力位X线片及颈椎MRI证实存在手术相邻节段影像学失稳，但为非责任节段。C4/5置换、C5/6失稳1例；C5/6置换4例，其中C4/5失稳3例，C6/7失稳1例；C6/7置换、C5/6失稳2例；双节段置换2例：C4/5、C5/6与C5/6、C6/7各1例，均为头端相邻节段失稳。术后1周及术后3、6、12、24、36个月行JOA评分、颈痛VAS评分及Odom评分评估手术临床疗效；术前及术后3、6、12、24、36个月在颈椎动力位X线片上测量置换节段、失稳节段、颈椎整体活动度（C2～C7）及颈椎曲度。结果：术后1周JOA评分、颈痛VAS评分与术前比较无统计学差异（P>0.05），术后3、6、12、24、36个月JOA评分、颈痛VAS评分较术前明显改善，差异有统计学意义（P<0.05）。术后1周和3个月时Odom评分均为优6例、良1例、可2例，优良率为77.8%；术后6个月优6例、良2例、可1例，优良率为88.9%；术后12、24及36个月，Odom评分均为优7例、良1例、可1例，优良率为88.9%。术后3、6、12个月置换节段、失稳节段的活动度和颈椎曲度与术前比较差异无统计学意义（P>0.05）；术后24、36个月，失稳节段的活动度较术前明显减小（P<0.05），置换节段活动度及颈椎曲度较术前明显增大（P<0.05）；术后各时间点C2～C7活动度较术前无统计学差异（P>0.05）。随访期间未发现假体松动、移位及下沉。结论：Bryan人工颈椎间盘置换治疗颈椎病的短中期临床疗效良好，能逐渐改善年轻颈椎病患者置换相邻节段的影像学失稳。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy and imaging results of the adjacent segment instability in patients with cervical spondylosis treated by Bryan cervical disc replacement. Methods: A retrospective review was performed on 9 cases suffering from adjacent segment instability before surgery. All 9 cases underwent Bryan artificial cervical disc arthoplasty and were followed up from July 2005 to January 2009 in our hospital. There were 4 males and 5 females with an average age of 33.5 years(range, 26-43 years). Japanese Orthopaedic Association(JOA) score was 10.16±3.17(7-13), and visual analogue pain scale(VAS) was 4.3±2.7(1-7) before surgery. All patients underwent cervical flexion and extension plain film and cervical MRI before surgery. Imaging instability was confirmed in the adjacent segment, which was asymptomatic. C4/5 replacement, 1 cases instability in C5/6; C5/6 replacement 4 cases, 3 cases instability in C4/5, 1 cases instability in C6/7; C6/7 replacement, 2 cases instability in C5/6. The double segment replacement 2 cases, each 1 cases instability in C4/5, C5/6 and C5/6, C6/7, which both are adjacent to the head-end segment. Clinical outcome of surgery was evaluated by JOA, neck pain VAS and Odom before surgery and at 1 week, 3, 6, 12, 24, 36 months after surgery respectively; the range of motion(ROM) of the surgical segment, adjacent unstable segment, C2-C7 and cervical malalignment were assessed by cervical dynamic X-ray before operation and 3, 6, 12, 24, 36 months after surgery. Results: The JOA score, neck pain VAS were improved significantly at each follow-up 3 months later after surgery compared with those of preoperation, difference was statistically significant(P<0.05). Odom score was excellent in 6 cases, good in 1 case, fair in 2 case, good rate of 77.8% 1 week and 3months after surgery, excellent in 6 cases, good in 2 case, fair in 1 case, good rate of 88.9% 6 months after surgery, excellent in 7 cases, good in 1 case, fair in 1 case, good rate of 88.9% 12, 24 and 36 months after surgery. The angular displacement and cervical curve of adjacent unstable segment at 3, 6, 12 months after operation showed no statistically significant difference compared with the preoperative ones(P>0.05), while decreased significantly at 24 and 36 months(P<0.05). ROM of implanted segment and cervical curve at 24 and 36 months after operation increased significantly(P<0.05) compared with preoperative ones. The postoperative ROM of C2-C7 remained unchanged at each follow-up compared with the preoperative ones. During the follow-up, no surgical related complications were noted. Conclusions: The short and medium term clinical result of Bryan artificial cervical disc replacement for cervical spondylosis is reliable, which can relieve adjacent segment instability.