单节段人工椎间盘置换治疗颈椎病的中长期疗效

Medium and long term result of the single level cervical disc arthroplasty for cervical spondylosis meylopathy

中文关键词:  颈椎病  人工椎间盘置换术  前路颈椎减压融合术  疗效  中长期

英文关键词:Cervical spondylosis  Cervical disc arthroplasty  Anterior cervical decompression and fusion  Outcome  Medium and long term

中文摘要:

  【摘要】 目的：评价单节段颈椎人工椎间盘置换（cervical disc arthroplasty，CDA）对颈椎病的中长期治疗效果。方法：2003年12月～2005年12月采用前瞻、随机、对照研究单节段Bryan假体CDA与传统前路颈椎减压融合（ACDF）手术治疗颈椎病的疗效，所有患者均按统一的纳入、排除标准进入临床研究，共80例，随机分为两组，并进行均衡性检验，一组进行CDA手术，另一组进行ACDF手术，术后经1d、3个月、6个月、1年、2年、5年及2012年6月的末次随访。其中CDA组32例、ACDF组35例完成了随访，应用动力位X线片观察置换间隙活动度，采用McAfee异位骨化分级方法评定颈椎间盘置换术后异位骨化情况，在MRI T2加权像上采用Miyaza?鄄ki颈椎间盘退变分级方法评定两组相邻节段椎间盘退变情况，采用颈椎活动障碍指数（NDI）和疼痛视觉模拟评分（VAS）评价术后症状改善程度。结果：本组病例随访7.2~9.6年，平均8.8年。CDA组假体位置良好，无塌陷或移位发生，末次随访时矢状面假体置换间隙活动度1.20°~8.20°，平均6.35°±1.45°；32例患者中8例（25％）置换间隙发生异位骨化，其中2例（6.25％）置换节段丧失活动度；翻修3例，1例因头侧邻近间隙退变、颈椎间盘突出压迫脊髓；2例因头侧跳跃间隙后方骨赘压迫脊髓；末次随访时置换间隙相邻的其他63个节段中22个椎间盘退变分级加重1级，8个加重2级，但无相关临床症状出现。ACDF组融合率100%，翻修3例，2例因头侧邻近间隙退变、存在神经症状；1例因尾侧邻近间隙退变，压迫脊髓；其余67个相邻节段中34个椎间盘退变分级加重1级，15个加重2级，但均无相关临床症状出现。末次随访时CDA组的NDI、颈部VAS及上肢VAS评分分别为16.83±3.12、1.17±0.41及1.96±0.51分，ACDF组分别为17.21±3.53、1.23±0.35及1.86±0.62分，较术前均显著改善，但两组间比较无显著性差异（P＞0.05）。结论：颈椎人工椎间盘置换术与ACDF手术治疗单节段颈椎病的中长期临床疗效间无显著性差异，颈椎人工椎间盘置换节段术后中长期可以保持一定活动度，相邻节段椎间盘退变情况好于ACDF组，可以作为单节段颈椎病的手术选择方式。

英文摘要:

  【Abstract】 Objectives: To investigate the medium and long term clinical outcome of the single level cervical disc arthroplasty(CDA) vs anterior cervical decompression and fusion(ACDF) in a randomized controlled study. Methods: The medium and long term clinical outcome of the single level Bryan prosthesis CDA(experimental group) and conventional ACDF(controlled group) was reviewed retrospectively. All the patients participated in a randomized controlled prospective study from 2003 to 2005, the inclusive criteria for cervical disc arthroplasty was used in 80 cases, and 32 patients was in CDA group and 35 patients in ACDF group finished the clinical and imaging follow-up(range, 7-9 years). The range of movement(ROM) in operation segement was determined by dynamic X-ray. The heterotopic ossification around the prosthesis was determined according to McAfee classification, the adjacent segment degeneration was verified according to Miyazaki classification on MRI T2 weighted images, and the symptom improvement was determined by NDI and VAS score. Results: The postoperative follow-up averaged 8.8 years, ranging from 7.2 to 9.6 years. No prosthesis displacement occurred in CDA group. Range of motion in CDA group averaged 6.35°±1.45°, ranging from 1.20° to 8.20°. The heterotopic ossification around the prosthesis was noted in 8 of 32(25%) segments, which induced loss of motion in 2 cases. 3 patients underwent the revision surgery due to 1 cranial adjacent segment degeneration and canal stenosis caused by ossification next to adjacent segment in 2 cases. The adjacent disc degeneration was noted as deterioration of 1 grade in 22 and 2 grade in 8 of the rest 63 segments, but remained asymptomatic. 3 patients underwent revision surgery in ACDF group, with cranial disc degeneration and neurological deficit in 2 and spinal cord compression due to caudal disc degeneration in 1. The adjacent disc degeneration was noted as deterioration of 1 grade in 34 and 2 grade in 15 of the rest 67 segments, but remained asymptomatic. The NDI, VAS score for neck and upper limb at final follow-up in CDA group was 16.83±3.12, 1.17±0.41 and 1.96±0.51 respectively; while in ACDF group, it was 17.21±3.53, 1.23±0.35 and 1.86±0.62 respectively. There was significant improvement compared with pre-operation, but no statistical difference between 2 groups(P＞0.05). Conclusions: No significant difference of medium and long term outcome exists between cervical disc arthroplasty and ACDF, while the former can maintain the ROM of involved segment as well as preventing ASD, which is optional for single level cervical spondylosis meylopathy.