Discover颈人工椎间盘置换术治疗颈椎病的临床研究

Clinical study on the Discover cervical artificial disc replacement for cervical spondylosis

中文关键词:  颈椎病  颈人工椎间盘置换术  颈椎前路减压融合术  颈椎运动功能

英文关键词:Cervical spondylosis  Cervical artificial disc replacement  Cervical anterior discectomy and fusion  Cervical spine motion

中文摘要:

  【摘要】 目的：比较分析Discover颈人工椎间盘置换术和颈椎前路减压融合术治疗颈椎病的临床疗效。方法：回顾分析2009年4月～2010年5月手术治疗的101例颈椎病患者，所有患者按照手术方法的不同分为人工椎间盘置换和椎间融合两组。其中人工椎间盘置换组46例（男27例，女19例，年龄46.2±10.3岁）采用Discover颈人工椎间盘置换术治疗。椎间融合组55例（男32例，女23例，年龄44.8±11.4岁）采用颈椎前路减压融合术治疗，分别对两组患者术前和末次随访时疼痛视觉模拟评分（visual analogue scale，VAS）﹑颈椎功能障碍指数（neck disability index，NDI）﹑术后症状改善优良率以及C2～C7的Cobb角（C2-C7角）、手术节段脊柱功能单位Cobb角（FSU角）、手术相邻节段活动度等影像学指标进行观察分析，评价患者的颈椎功能改善情况，并进行两组间的对比分析。结果：椎间融合组手术时间为149.3±51.7min，术中出血量为213.5±42.6ml；人工椎间盘组手术时间为132.5±44.1min，术中出血量为173.2±56.4ml，两组间比较无统计学差异（P>0.05）。人工椎间盘组和椎间融合组随访时间分别为24.2±3.2个月和25.6±2.9个月。随访期间两组均未发现假体或植骨松动及移位，无内固定松动及断裂。两组患者术后神经功能均有显著恢复，疼痛症状明显改善，椎间融合组VAS及NDI评分末次随访时分别较术前下降了65.1%和63.7%，人工椎间盘组分别下降了67.1%和63.6%，两组之间比较无统计学差异（P>0.05）。末次随访时椎间融合组C2-C7角和FSU角较术前分别下降了28.1%和68.8%，手术相邻上节段和下节段活动度较术前分别上升了21.3%和28.4%，差异有显著性（P<0.05）；人工椎间盘组C2-C7角﹑FSU角较术前分别上升了7.7%和11.2%，手术相邻上节段及下节段活动度较术前分别上升了5.5%及9.3%，差异无统计学意义（P>0.05）。C2-C7角﹑FSU角和手术相邻节段活动度术后改变两组间比较有统计学差异（P<0.05）。人工椎间盘组和椎间融合组术后症状改善优良率分别为91.3%和87.3%，两组间比较无统计学差异（P>0.05）。结论：采用Discover颈人工椎间盘置换术治疗颈椎病能够取得和颈椎前路减压融合术相近的临床疗效，同时手术节段运动功能得到了保留，手术相邻节段的活动度并无增加，可作为颈椎病的有效治疗方法。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcome of the Discover cervical artificial disc replacement and anterior cervical discectomy and fusion(ACDF). Methods: From April 2009 to May 2010, a total of 101 cases of cervical spondylosis was retrospectively reviewed. All the patients were divided into Discover group and fusion group. 46 cases in Discover group(27 males, 19 females, mean age of 46.2±10.3 years) underwent Discover cervical artificial disc replacement, while 55 cases in fusion group(32 males, 23 females, mean age of 44.8±11.4 years) underwent ACDF. The visual analogue scale(VAS), neck disability index(NDI), excellent and good improvement rate and the Cobb angle of C2-C7, the functional spinal unit(FSU) angle of operative segment, the mobility of adjacent level between two groups were statistically analyzed and compared to evaluate the functional improvement of cervical spine and clinical effects of surgeries. Results: The operation time and intraoperative blood loss in fusion group was 149.3±51.7min and 213.5±42.6ml respectively. The corresponding values in the Discover group were 132.5±44.1min and 173.2±56.4ml respectively. No significant differences were found between two groups(P>0.05). The follow-up period for Discover and fusion group was 24.2±3.2 and 25.6±2.9 months respectively. No loosening, displacement or breakage of the implant was found in the two groups during the follow-up. The postoperative VAS and NDI scores improved significantly(P＜0.05) in both groups and no significant difference was found between two groups(P>0.05). The excellent and good improvement rate for Discover and fusion group was 91.3% and 87.3% respectively, which showed no statistical difference between two groups(P>0.05). No significant difference was found between the preoperative and postoperative C2-C7 Cobb angle, FSU angle and range of motion at adjacent segments in Discover group(P>0.05), but significant differences were found in fusion group (P<0.05). There were statistical differences with respect to all these parameters between 2 groups(P<0.05). Conclusions: The Discover cervical artificial disc replacement can achieve the similar clinical effect to the ACDF for cervical spondylosis, the former can preserve the cervical movement of surgical segments and have no influence on the mobility of the adjacent segments, which is an effective option for cervical spondylosis.