人工颈椎间盘置换术治疗颈椎病的临床疗效分析

Clinical outcomes of artificial cervical disc replacement in cervical spondylosis

中文关键词:  颈椎病  人工颈椎间盘置换术  颈前路减压融合术  临床疗效

英文关键词:Cervical spondylosis  Artificial cervical disc replacement  Anterior cervical decompression and fusion  Clinical effect

中文摘要:

  【摘要】 目的：评价人工颈椎间盘置换术（ACDR）治疗颈椎病的临床疗效，并与同期行颈前路减压融合术（ACDF）的患者进行比较。方法：对2009年7月～2015年4月收治的21例行ACDR的颈椎病患者进行回顾性分析（ACDR组），男17例，女4例，年龄20~49岁（39.1±6.8岁）；C3/4 4例，C4/5 6例，C5/6 9例，C6/7 2例。同时收集同期行ACDF的21例颈椎病患者（ACDF组） 进行对比，男16例，女5例，年龄23~53岁（39.5±6.3岁）；C3/4 4例，C4/5 7例，C5/6 8例，C6/7 2例。术后随访时拍摄颈椎X线片，测量颈椎曲度、手术节段活动度（ROM），观察椎间盘假体有无松动移位及异位骨化、椎间融合器有无出现松动移位及植骨融合等情况；按照JOA评分、疼痛视觉模拟量表评分（VAS）、颈椎功能障碍指数（NDI）和Odom′s分级评估临床疗效。结果：两组病例术后随访4～9年（5.7±1.2年），两组随访时间无统计学差异（P>0.05）。末次随访时无椎间盘假体和椎间融合器的松动和移位。ACDR组出现1例异位骨化，未出现明显邻近节段退变的病例；术前与末次随访时的颈椎曲度和手术节段ROM差异无统计学意义（P>0.05）。ACDF组X线片显示手术节段全部骨性融合，5例出现明显邻近节段退变（ASD），其中3例无临床症状，2例临床症状较重再次行手术治疗；末次随访时颈椎曲度和手术节段ROM与术前比较有统计学差异（P＜0.05）。两组末次随访时JOA评分、VAS评分和NDI与同组术前比较差异均有统计学意义（P＜0.05），两组间同时间点比较差异均无统计学意义（P>0.05）。末次随访时ACDR组Odom′s分级优良率为90.5%，ACDF组为85.7%，两组比较差异有统计学意义（P＜0.05）。两组ASD发生率有统计学意义（ACDR 0 vs ACDF 23.8%，P＜0.05）。结论：ACDR治疗颈椎病可取得较好的中长期效果，能够保留置换节段ROM和颈椎生理曲度，减少ASD发生。

英文摘要:

  【Abstract】 Objectives: To observe and analyze the clinical effect of artificial cervical disc replacement(AC?鄄DR) in cervical spondylosis, and to compare the effect with that of anterior cervical decompression and fusion (ACDF) in the same period. Methods: A retrospective analysis was performed on 21 patients with cervical spondylopathy who were treated with ACDR from July 2009 to April 2015. The ACDR group included 17 males and 4 females, aged from 20 to 49 years with an average age of 39.1±6.8 years. There were 4 cases of C3/4, 6 cases of C4/5, 9 cases of C5/6, and 2 cases of C6/7. 21 cases of cervical spondylopathy patients received ACDF in the same period were collected for comparison. The ACDF group included 16 males and 5 females, aged 23-53 years with an average age of 39.5±6.3 years. There were 4 cases of C3/4, 7 cases of C4/5, 8 cases of C5/6, and 2 cases of C6/7. Postoperative follow-up included: X-ray film, cervical curvature, range of motion(ROM) in surgical segment, disc prosthesis loosing and displacement, ectopic ossification, inter?鄄vertebral fusion device loosing and displacement, and bone graft fusion. JOA score, visual analogue scale of pain score(VAS), neck disability index (NDI) and Odom′s grading were used to evaluate the clinical outcomes.Results: The patients in the two groups were followed up for 4-9 years, with an average of 5.7±1.2 years. There was no significant difference between the two groups in the follow-up time. No loosening or displace?鄄ment of disc prosthesis or intervertebral fusion device was observed at the last follow-up. ACDR group pre?鄄sented 1 case of ectopic ossification without obvious adjacent segment degeneration. There was no significant difference of cervical curvature and surgical segment ROM between preoperation and the last follow-up(P>0.05). X-ray in ACDF group showed osseous fusion of all surgical segments. There were 5 cases with obvious adjacent segment degeneration(ASD) in X-ray, among which 3 cases had no clinical symptoms, and 2 cases had severe clinical symptoms and underwent surgical treatment again. The cervical curvature and surgical segment ROM at preoperation and the last follow-up were with significant differences(P<0.05). There were sig?鄄nificant differences in the JOA, VAS and NDI scores in both groups at preoperation and the last follow-up(P<0.05), but there was no statistically significant difference of the scores between the two groups(P>0.05). The excellent and good rate of Odom′s classification at the last follow-up in ACDR group was 90.5%, and that in ACDF group was 85.7%, with significant difference between the groups(P<0.05). The incidence of ASD between the groups had statistically significant difference(ACDR 0 vs ACDF 23.8%, P<0.05). Conclusions: ACDR has satisfactory outcomes in mid- and long-term follow-up for cervical spondylosis, which can retain the motion range of the replacement segment, reconstruct the maximum possible cervical curvature, and reduce the degeneration of adjacent segments.