人工颈椎间盘置换术后假体周围骨吸收的发生情况及影像学研究

Periprosthetic bone loss after artificial cervical disc replacement: an imaging study

中文关键词:  骨吸收  人工颈椎间盘置换术  颈椎病  并发症

英文关键词:Periprosthetic bone loss  Artificial disc replacement  Cervical spondylosis  Complications

中文摘要:

  【摘要】 目的：探讨人工颈椎间盘置换（artificial cervical disc replacement，ACDR）术后假体周围骨吸收的发生情况，并分析假体周围骨吸收的影像学特点。方法：回顾性分析2009年1月～2016年8月67例因颈椎病行ACDR患者的临床资料。其中男38例，女29例，平均年龄41.4±6.1岁，平均随访时间88.6±14.5月。术前诊断为脊髓型颈椎病患者41例，神经根型颈椎病患者21例，混合型颈椎病患者5例。手术节段C3/4者8例，C4/5者18例，C5/6者30例，C6/7者11例。根据末次随访时有无骨吸收出现，将纳入病例分成为骨吸收组（A组，25例）和无骨吸收组（B组，42例）。对术后假体周围骨吸收的发生率、分级、影像学参数特点以及手术相关并发症的情况进行统计分析。结果：术后半年、1年、2年、4年、末次随访时的骨吸收发生率分别为5.98%、7.46%、11.94%、26.87%、37.31%。末次随访时骨吸收发生在C3/4节段3例，C4/5节段7例，C5/6节段11例，C6/7节段4例；其中1级骨吸收12例，2级骨吸收9例，3级骨吸收4例。末次随访时，影像学参数中两组的颈椎ROM、手术节段ROM、T1S、颈椎Cobb角无显著差异（P＞0.05）；A组SVA显著大于B组（P=0.02）。A组上位椎体终板矢状径、椎体高度显著小于下位椎体（P＜0.05）。术后并发症情况比较，声音嘶哑、吞咽困难、自发融合情况两组间无显著差异；A组轴性疼痛的发生率显著高于B组（P=0.02）。结论：ACDR术后假体周围骨吸收较常见，多数假体周围骨吸收为1～2级，且上位椎体骨吸收程度更为显著。术后假体周围骨吸收患者随访期间轴性疼痛发生率更高。

英文摘要:

  【Abstract】 Objectives: To investigate the incidence of periprosthetic bone loss(PBL) after artificial cervical disc replacement(ACDR), and analyze the imaging characteristics of PBL. Methods: 67 patients treated by ACDR from January 2009 to August 2016 were retrospectively reviewed. There were 38 males and 29 females with an average age of 41.4±6.1 years. The mean follow-up time was 88.6±14.5 months. There were 41 patients with cervical spondylotic myelopathy, 21 patients with cervical spondylotic radiculopathy and 5 patients with cervical radiculomyelopathy. According to the occurrence of PBL, the patients were divided into PBL group(group A, 25 cases) and no PBL group(group B, 42 cases). The incidence, classification, imaging characteristics of PBL and operation related complications were analyzed. Results: Incidence rate of PBL was 5.98%, 7.46%, 11.94%, 26.87% and 37.31% at 6 months, 1 year, 2 years, 4 years postoperatively and final follow-up, respectively. At final follow-up, PBL observed at C3/4 in 3 cases, C4/5 in 7 cases, C5/6 in 11 cases and C6/7 in 4 cases. There were 12 cases of grade 1, 9 cases of grade 2 and 4 cases of grade 3 PBL. At final follow-up, there was no significant difference in cervical ROM, segment ROM, T1S and Cobb angle between the two groups(P>0.05). SVA in group A was significantly higher than that in group B(P=0.02). In PBL group, the sagittal diameter and height of the upper vertebral body were significantly smaller than those of the lower vertebral body(P＜0.05). There was no significant difference in hoarseness, dysphagia and spontaneous fusion between the two groups. The incidence of axial pain in group A was significantly higher than that in group B(P=0.02). Conclusions: PBL is commonly observed after ACDR. Most of the PBL is grade 1-2, and PBL in the upper vertebral body usually is more serious. The incidence of axial pain is higher in patients with PBL.