影响神经根型颈椎病人工颈椎间盘置换术疗效的相关因素分析

Associated factors of disc replacement for cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  人工椎间盘置换  预后因素

英文关键词:Cervical spondylotic radiculopathy  Artificial disc replacement  Prognostic factors

中文摘要:

  【摘要】 目的：探讨影响神经根型颈椎病（cervical spondylotic radiculopathy，CSR）人工颈椎间盘置换术（cervical total disc replacement，CTDR）疗效的因素。方法：回顾性研究2012年5月~2014年5月长征医院骨科收治的接受CTDR的CSR患者45例，随访6个月~2年（1.4±0.5年）。满足以下条件为显效组：（1）末次随访颈部伤残指数（neck disability index，NDI）评分改善（术前NDI评分-末次随访NDI评分）＞15分；（2）术后末次随访手术节段未出现神经根受损；（3）未出现手术失败及二次手术；（4）随访复查颈椎正侧位、动力位及左右侧屈X线片未见人工椎间盘移位、活动受限及假体相关问题。不满足以上任意一条者为无显效组。比较两组间背景资料及主观变量,分析其手术效果的影响因素，背景资料包括性别、年龄、病程、吸烟史、肌电图确诊神经根受损、受压神经根所支配的肌肉肌力、手术节段数量、术前颈椎活动度（ROM）、手术时间及术中出血量，主观变量包括疼痛视觉模拟评分（visual analogue score，VAS）及NDI。结果：显效组34例，无显效组11例。两组间年龄、病程、吸烟史、肌电图确诊神经根受损例数、术前肌力、术前VAS及NDI评分差异均有统计学意义（P＜0.05），两组间性别比、术前颈椎ROM、手术节段数量、手术时间、术中出血量比较均无统计学差异（P＞0.05）。结论：患者年龄、病程、吸烟史、肌电图确诊神经根受损、术前肌力、术前VAS及NDI评分可能与CSR患者CTDR的疗效有关。

英文摘要:

  【Abstract】 Objectives: To investigate the associated factors of cervical disc replacement for cervical spondylotic radiculopathy(CSR). Methods: A retrospective study of 45 patients undergoing cervical total disc replacement(CTDR) in orthopedics of Changzheng Hospital from May 2012 to May 2014 was carried out. The follow-up was 6 months to 2 years, with an average of 1.4 years. Group was considered as effective when having following conditions: (1)neck disability index(NDI) scores improved(last follow-up NDI score-preoperative NDI score)>15; (2)at final follow-up, surgery segmental nerve root was kept intact; (3)no failed surgery and revision surgery; (4)and radiologically, no limited mobility and prosthesis-related problems. Anyone who was not satisfied was in no effective group. The general data and subjective variables were compared between two groups. General data included gender, age, duration of disease, smoking history, nerve damage under EMG detection, preoperative muscle strength, number of surgical segment, cervical ROM, operation time, blood loss. Subjective variables included: visual analogue scale(VAS) and NDI scores. The prognostic factors were investigated to provide the basis for clinical practice. Results： 34 cases in effective group and 11 cases in no effective group were noted. The differences of age, disease duration, smoking history, nerve damage under EMG, preoperative VAS, NDI were statistically significant between 2 groups(P<0.05). Sex, number of surgery segment, cervical ROM, operative time, blood loss showed no significant difference for prognosis(P>0.05). Conclusions: Patient age, disease duration, smoking history, nerve damage under EMG, preoperative muscle strength, preoperative VAS score and preoperative NDI may be related to CTDR in CSR patients.