单节段人工颈椎间盘置换术后小关节退变的长期临床研究

A long-term clinical study of facet joint degeneration after cervical artificial disc replacement

中文关键词:  颈椎退行性疾病  人工颈椎间盘置换术  小关节退变  节段活动度

英文关键词:Cervical degenerative disease  Artificial disc replacement  Facet joint degeneration  Segmental range of motion

中文摘要:

  【摘要】 目的：分析人工颈椎间盘置换（artificial cervical disc replacement，ACDR）术后颈椎小关节退变的危险因素，评价其对颈椎节段运动和临床疗效的影响。方法：回顾性分析我科2003年1月~2008年1月行单节段Bryan人工颈椎间盘ACDR术的颈椎退行性疾病患者70例，其中男性43例，女性27例；术后随访时间129±14（105~165）个月；年龄55.7±8.4（37~76）岁。术前、术后及末次随访时通过颈椎动力位X线片测量手术节段活动度和颈椎整体活动度；术前、末次随访时通过CT影像根据颈椎小关节定量评分系统评估颈椎小关节退变程度。术前及末次随访同时进行日本骨科协会（Japanese Orthopaedic Association，JOA）评分及颈椎功能障碍指数量表（neck disability index，NDI）评估患者临床症状，在末次随访时进行Odom标准评价分级和颈痛的视觉模拟评分（visual analogue scale，VAS）。结果：术前小关节无或轻度退变患者41例，中度退变患者28例，重度退变患者1例；末次随访时，小关节轻度退变患者16例，中度患者退变35例，重度关节退变患者19例。通过斯皮尔曼双变量相关性检验发现小关节退变与性别、年龄有相关性。高龄、男性是小关节退变增加的危险因素，手术节段与小关节退变程度无相关性。患者术前和末次随访时手术节段活动度不存在统计学差异（9.7°±4.5° vs 8.7°±5.4°，P>0.05），术前和末次随访时颈椎整体活动度不存在统计学差异（46.5°±15.2° vs 46.1°±13.0°，P>0.05）。患者术前及末次随访时小关节退变评分具有统计学差异（1.5±0.8分 vs 2.6±1.2分，P<0.05）；术前与末次随访时JOA评分具有统计学差异（13.5±1.9分 vs 16.5±1.4分，P<0.05）；术前与末次随访时NDI存在统计学差异（0.27±0.08 vs 0.16±0.10，P<0.05）。末次随访时Odom分级为优秀的有35例患者，为良好的有29例，为尚可的有6例，没有分级为差的患者，末次随访时VAS评分为3.47±1.55分。ACDR术后末次随访小关节退变程度与手术节段活动度呈负相关（r=-0.392，P=0.001），与整体活动度也呈负相关（r=-0.388，P=0.001），与JOA评分、NDI、Odom分级、VAS评分无显著性相关（P>0.05）。结论：高龄和男性是ACDR术后小关节退变的危险因素，小关节的退变程度与患者术后的颈椎活动度存在负相关，小关节退变程度与临床症状的缓解程度无关。

英文摘要:

  【Abstract】 Objectives: To evaluate the risk factors of single segment cervical facet joint degeneration after artificial cervical disc replacement(ACDR), and the influence of facet joint degeneration on cervical segmental motion and clinical symptoms. Methods: We performed a retrospective analysis on 70 patients with cervical degenerative disease, who underwent single-level Bryan cervical artificial disc replacement in our department from January 2003 to January 2008. A 10-year clinical follow-up was conducted. There were 43 males and 27 females. The mean postoperative follow-up time was 129±14(105-165) months. The average age was 55.7±8.4(37-76)years. The cervical spine segment range of motion (ROM) was measured using cervical dynamic position X-ray film at preoperation, postoperation and final follow-up. The degree of cervical facet joint de?鄄generation was assessed using CT images according to the quantitative scoring system of cervical small joints preoperatively and at final follow-up. Clinical evaluation including the Japanese Orthopaedic Association(JOA) score, neck disability index (NDI) were performed in the preoperative evaluation and final follow-up. Odom standard grading and visual analogue scale (VAS) were performed at final follow-up. Results: Before surgery, 41 patients had none or mild degeneration of the facet joints, 28 patients had moderate degeneration, and 1 patient had severe degeneration. At final follow-up, there were 16 patients with mild degeneration of facet joints, 35 patients with moderate degeneration, and 19 patients with severe joint degeneration. The small joint degeneration was found to be correlated with gender and age using Szpilman bivariate correlation test. Male was a risk factor for the facet joint degeneration. There was no correlation between surgical segment and the degree of facet joint degeneration. There was no statistically significant difference in the preoperative and final follow-up segment ROM (9.7°±4.5° vs 8.7°±5.4°, P>0.05), and no statistically significant difference in the overall cervical ROM (46.5°±15.2° vs 46.1°±13.0°, P>0.05). There was a statistically significant difference in the score of facet joint degeneration between the preoperative and final follow-up (1.5±0.8 vs 2.6±1.2, P<0.05). There was a significant difference in JOA score between preoperative and final follow-up(13.5±1.9 vs 16.5±1.4, P<0.05). There was a statistical difference in NDI score between preoperative and final follow-up (0.27±0.08 vs 0.16±0.10, P<0.05). At final follow-up, there were 35 patients with excellent Odom grading, 29 patients with good Odom grading, 6 patients with normal Odom grading, and no patients with poor Odom grading. VAS score was 3.47±1.55 at final follow-up. The degree of facet joint degeneration at final follow-up was negatively correlated with the ROM of the operative segment and the overall cervical spine (P<0.05), and it was not significantly correlated with JOA, NDI, Odom grading and VAS. Conclusions: Elder age and male are the risk factors of facet joint degeneration. There was a degree of degeneration of facet joints after long-term follow up of ACDR surgery. There was a negative correlation between the degree of facet joint degenera?鄄tion and the degree of cervical postoperative mobility. The degree of facet joint degeneration was not related to the clinical symptom.