连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期研究

A long-term study of heterotopic ossification after consecutive double-segment Bryan artificial cervical disc replacement

中文关键词:  Bryan人工间盘  颈椎病  异位骨化  长期观察

英文关键词:Bryan artificial intervertebral disc  Cervical spondylosis  Heterotopic ossification  Long-term follow-up

中文摘要:

  【摘要】 目的：对连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期观察研究。方法：回顾性分析我科2004年1月~2011年12月行连续双节段人工颈椎间盘置换术的患者21例，其中男性15例，女性6例；年龄33~72岁，平均50.4±8.8岁。C3/4、C4/5间盘置换5例，C4/5、C5/6间盘置换14例，C5/6、C6/7间盘置换2例。随访时间96~156个月，平均随访116.5±19.6个月。记录患者术前、术后3个月及末次随访时改良日本骨科协会评分（modified Japanese Orthopaedic Association，mJOA）、视觉模拟评分法（visual analogue scale，VAS）评分，末次随访时在颈椎动力位X线片中测量人工颈椎间盘活动度，颈椎侧位X线片中测量颈椎曲度，采用McAfee分级法在颈椎侧位及动力位X线片上对人工颈椎间盘的异位骨化情况进行评估。结果：患者术前mJOA评分14.0±2.0分。术后3个月时mJOA评分15.2±1.8分，末次随访时mJOA评分16.8±1.2分，均较术前有统计学差异（P＜0.05）。术前VAS评分5.1±1.7分。术后3个月时VAS评分1.9±1.4分，末次随访时VAS评分0.9±0.8分，均较术前有统计学差异（P＜0.05）。术前颈椎曲度为平均16.7°±6.6°，末次随访时颈椎曲度为15.7°±7.3°，无统计学差异（P=0.25）。上位节段活动度为6.23°±10.13°，下位节段活动度为3.76°±4.81°，有统计学差异（P=0.025）。至末次随访时16例发生异位骨化，发生率为76.2%。根据McAfee分级，21例患者42个节段中，Ⅰ级5个节段，Ⅱ级5个节段，Ⅲ级14个节段，Ⅳ级7个节段，发生Ⅲ级以上HO的概率为50%，上位节段发生Ⅲ级和Ⅳ级HO的概率为38.0%，下位节段发生Ⅲ级和Ⅳ级HO的概率为61.9%。结论：长期随访发现行连续双节段Bryan人工颈椎间盘置换术后异位骨化发生率较高，且下位节段发生严重HO的概率明显增加。

英文摘要:

  【Abstract】 Objectives: To observe the long-term follow-up outcome of cases underwent continuous double-segment Bryan artificial disc replacement over 8 years. Methods: A total of 21 patients who underwent con?鄄tinuous double segment artificial cervical disc replacement in our hospital from Jan 2004 to Dec 2011 were enrolled. Among them, 4 cases presented radiculopathy, 15 cases myelopathy, and 2 cases mixed type. There were 14 cases of C4/5 and C5/6 disc replacement, 2 cases of C5/6 and C6/7 disc replacement, and 5 cases of C3/4 and C4/5 disc replacement. The mean follow-up time was 116.5±19.6 months. mJOA and VAS scores were recorded at pre-operation, 3 months after surgery and final follow-up. The patients′ segmental range of motion (ROM) was measured on the cervical dynamic X-ray film. The cervical lordosis was measured by lat?鄄eral cervical X-ray film at final follow-up. The ectopic ossification of the artificial disc was evaluated on the cervical lateral X-ray film using McAfee classification method. Results: The mJOA score of 21 patients was 14.0±2.0 points at preoperation, 15.2±1.8 at 3 months after surgery, and 16.8±1.2 at final follow-up. There were statistical differences between the postoperative scores andpreoperation score(P<0.05). The preoperative VAS score was 5.1±1.7 points, and the VAS score 3 months after surgery was 1.9±1.4, the VAS score at fi?鄄nal follow-up was 0.9±0.8. The differences between the postoperative scores and preoperation score were with statistical significance. The cervical curvature before surgery was 16.7°±6.6° on average. The average cervical lordosis was 15.7°±7.3° at final follow-up. There was no statistical difference between that of preoperation and final follow-up (P=0.25). At final follow-up, the upper segment ROM was 6.23°±10.13° and the lower segment ROM was 3.76°±4.81°, the difference was with statistical significance(P=0.025). 16 cases developed heterotopic ossification at final follow-up, with an incidence of 76.2%. According to McAfee classification, among the 42 segments of 21 patients, 5 segments were of level Ⅰ, 5 segments level Ⅱ, 14 segments level Ⅲ, and 7 seg?鄄ments level Ⅳ. The probability of HO with level Ⅲ and above was 50%. Furthermore, it was found that the occurrence rate of level Ⅲ and Ⅳ HO in the upper segment was 38.0%, and that in the lower segment was 61.9%. The incidence of HO in the posterior vertebral margin of the lower segment was 71.4%, and that in the upper segment was 42.9%. Conclusions: The present study revealed a high incidence of ectopic ossifica?鄄tion after continuous double-segment Bryan cercical disc replacement at the long-term follow-up, and the low?鄄er segment is more likely to have severe HO.