颈椎人工椎间盘置换术治疗脊髓型颈椎病的长期疗效

Long-term efficacy of cervical artificial disc replacement for the treatment of cervical spondylotic myelopathy

中文关键词:  颈椎人工间盘置换术  脊髓型颈椎病  Bryan人工椎间盘  长期随访

英文关键词:Cervical artificial disc replacement  Cervical spondylotic myelopathy  Bryan disc  Long-term follow-up

中文摘要:

  【摘要】 目的：观察颈椎人工椎间盘置换术治疗脊髓型颈椎病的长期疗效。方法：回顾性分析我院2003年12月～2007年12月17例因脊髓型颈椎病行单节段Bryan人工椎间盘置换术且随访10年以上患者的临床资料，手术时年龄37~76岁（平均57.2±8.9岁），男13例，女4例。手术节段：C4/5 3例，C5/6 9例，C6/7 5例。依据术前CT及MRI检查结果将患者分为两组：单纯颈椎间盘突出组7例，合并骨赘形成组10例。分别于术前及末次随访时评估患者影像学指标，包括颈椎整体活动度（ROM）、手术节段ROM、手术节段Cobb角与高等级（3～4级）椎旁骨化；临床功能评价指标包括JOA评分、颈椎功能障碍指数（NDI）及Odom′s评定。比较两组间各评价指标的差异及组内术前术后各指标差异。计量数据使用t检验进行统计分析，等级数据使用非参数检验中的Mann-Whitney检验进行统计分析，P<0.05为有显著性差异。结果：单纯颈椎间盘突出组患者手术时年龄56.1±11.7岁，男5例，女2例，C5/6节段3例，C6/7节段4例，手术节段ROM术前为8.18°±3.70°，末次随访时为9.07°±4.76°，1例出现ROM丧失；颈椎整体ROM术前为42.78°±14.89°，末次随访时为47.34°±6.93°；手术节段Cobb角术前为2.77°±1.08°，末次随访时为2.37°±1.48°；各影像学评估指标（颈椎整体ROM、手术节段ROM、手术节段Cobb角）末次随访时与术前比较无显著性差异（P＞0.05）；1例（14.3%）出现局部后凸，1例出现高等级椎旁骨化。合并骨赘形成组患者手术时年龄57.9±7.0岁，男8例，女2例，C4/5节段3例，C5/6节段6例，C6/7节段1例，手术节段ROM术前为11.46°±5.19°，末次随访时为6.41°±4.87°，3例出现ROM丧失；颈椎整体ROM术前为45.53°±11.89°，末次随访时为41.60°±13.45°；手术节段Cobb角术前为2.14°±1.35°，末次随访时为1.29°±1.33°，末次随访时手术节段ROM及Cobb角较术前明显下降（P<0.05），1例出现局部后凸，4例出现高等级椎旁骨化。末次随访时，单纯颈椎间盘突出组患者JOA评分改善率为（76.73±25.53）%，NDI%下降（12.29±6.26）%，Odom′s标准评定优良率为100.0%；合并骨赘形成组患者JOA评分改善率为（82.90±19.03）%，NDI%下降（10.00±4.32）%，Odom′s标准评定优良率为100.0%。术前及末次随访时颈椎整体ROM、手术节段ROM、手术节段Cobb角、JOA评分、NDI%及Odoms评分两组比较均无显著性差异（P＞0.05）。结论：颈椎人工椎间盘置换术治疗脊髓型颈椎病具有较好的长期疗效。单纯颈椎间盘突出导致的脊髓型颈椎病患者人工椎间盘置换术后远期手术节段ROM的维持优于合并骨赘形成患者。

英文摘要:

  【Abstract】 Objectives: To evaluate the long-term efficacy of cervical artificial disc replacement in patients with cervical spondylotic myelopathy. Methods: Retrospective analysis of 17 patients who underwent single-level Bryan artificial disc replacement for cervical spondylotic myelopathy with more than 10 years follow-up in our hospital between December 2003 and December 2007. The age ranged from 37 to 76 years(mean age, 57.2±8.9 years), including 13 males and 4 females. The involved levels were 3 cases of C4/5, 9 cases of C5/6, 5 cases of C6/7. According to the results of preoperative CT and MRI examination, the patients were divided into two groups, 7 patients in group of simply cervical disc herniation and 10 patients in group of combined with osteophyte. The radiographic evaluation indexes included the global and segmental range of motion(ROM), Cobb angle and incidence of high grade(grade 3-4) paravertebral ossification(PO) of operated segment. The clinical indexes included Japanese Orthopaedic Association(JOA) score, neck disability index(NDI) and Odom′s standard. The differences of clinical indexes and radiographic evaluation indexes were analyzed between the two groups, and in each group the difference was compared between preoperation and final fellow-up. The continuous variable data were analyzed by t-test. The grading evaluation data were analyzed by Mann-Whitney test. A P<0.05 was considered statistically significant. Results: The mean age of disc herniation group was 56.1±11.7 years old, including 5 males and 2 females, and 3 cases of C5/6 level, 4 cases of C6/7 level. The preoperative segmental ROM was 8.18°±3.70° and 9.07°±4.76° at final follow-up, mobility lost occurred in 1 case(14.3%); the preoperative global ROM was 42.78°±14.89° and 47.34°±6.93° at final follow-up, the preoperative segmental Cobb angle was 2.77°±1.08° and 2.37°±1.48° at final follow-up, segmental kyphosis occurred in 1 case, and the high level PO rate was 14.3%. The radiographic evaluation indexes(global and segmental ROM, and Cobb angle of operated segment) had no difference between preoperation and final follow-up. The mean age of combined osteophyte group was 57.9±7.0 years old, including 8 males and 2 females, and 3 cases of C4/5 level, 6 cases of C5/6 level, 1 case of C6/7 level. The preoperative segmental ROM was 11.46°±5.19° and 6.41°±4.87° at final follow-up, 3 cases(30.0%) occurred mobility lost; the preoperative global ROM was 45.53°±11.89° and 41.60°±13.45° at final follow-up, the preoperative segmental Cobb angle was 2.14°±1.35° and 1.29°±1.33° at final follow-up, segmental kyphosis occurred in 1 case, and the high level PO rate was 40.0%. The segmental ROM and Cobb angle were significantly decreased at final follow-up(P<0.05). In disc herniation group, the improvement rate of JOA score was (76.73±25.53)%, NDI% decreased by (12.29±6.26)%, and the satisfaction rate of Odom′s standard was 100.0%. In combined osteophyte group, the improvement rate of JOA score was (82.90±19.03)%, NDI% decreased by (10.00±4.32)%, and the satisfaction rate of Odom′s standard was 100.0%. The global and segmental ROM, Cobb angle of operated segment, JOA score, NDI% and Odom′s criteria had no significant difference between the two groups at final follow-up(P＞0.05). Conclusions: Cervical artificial disc replacement has a satisfied long-term clinical efficacy in the treatment of cervical spondylotic myelopathy. The maintenance of ROM at operated level of cervical artificial disc replacement in cervical spondylotic myelopathy patients caused by simply disc herniation is better than those caused by osteophyte.