颈椎前路Hybrid术式治疗相邻双节段颈椎病的中长期疗效分析

Analysis of mid- to long-term follow-up outcomes after anterior cervical Hybrid surgery for the treatment of adjacent two-level cervical spondylosis

中文关键词:  颈椎病  颈椎前路Hybrid手术  Bryan人工颈椎间盘  关节突关节  旋转中心  邻近节段退变

英文关键词:Cervical spondylosis  Anterior cervical Hybrid surgery  Bryan artificial cervical disc  Zygapophyseal joints  Center of rotation  Adjacent segment degeneration

中文摘要:

  【摘要】 目的：观察颈椎前路Hybrid术式治疗相邻双节段颈椎病的中长期临床疗效、影像结果及Bryan人工颈椎间盘置换节段的在体运动功能状态。方法：回顾性分析2010年7月～2013年12月于我院行颈椎前路相邻双节段Hybrid手术的患者，置换节段采用Bryan人工颈椎间盘，融合节段采用MC+椎间融合器，纳入末次随访时置换节段活动度（range of motion，ROM）＞5°的43例患者，其中男性23例、女性20例，年龄49.1±5.6岁。脊髓型颈椎病26例，神经根型颈椎病6例，混合型颈椎病11例。术后随访84~119个月（95.43±8.21个月），采用日本骨科协会（Japanese Orthopaedic Association，JOA）颈椎评分、颈椎功能障碍指数（neck disability index，NDI）、疼痛视觉模拟评分（visual analogue scale，VAS）及Odom分级评估临床疗效。收集术前与末次随访时的颈椎中立侧位和动力位X线片，对比术前与末次随访时的颈椎整体ROM及曲度（C2-C7）、手术节段曲度、置换节段屈伸旋转中心（flexion and extension-center of rotation，FE-COR）及ROM、手术相邻节段ROM；末次随访时，观察邻近节段退变（adjacent segment degeneration，ASD）发生情况、融合节段融合情况，测量置换节段平移距离与关节突关节解剖参数：上关节突高度（height of superior articular process，HSAP）、关节突关节间隙倾斜度（orientation of zygapophyseal joint spaces，OZJS）和上关节突关节面长度（length of superior articular surface，LSAS），分析置换节段FE-COR与各项随访指标的相关性。结果：末次随访时，JOA评分较术前显著性升高（9.26±3.38 vs 15.21±1.42，P＜0.05），改善率为（80.23±13.80）%，NDI、颈痛VAS评分及双上肢痛VAS评分均较术前显著性降低（34.12±8.96 vs 7.21±4.32，P＜0.05；5.77±2.28 vs 1.72±0.96，P＜0.05；5.26±2.67 vs 1.14±0.83，P＜0.05），改善率分别为（80.03±10.52）%、（69.85±13.44）%和（78.84±15.89）%。Odom分级优24例、良12例、可7例，优良率为83.72%。颈椎整体曲度、手术节段曲度分别由术前的14.76°±8.04°、4.78°±5.86°增加至末次随访的20.62°±9.06°、6.75°±4.65°（P＜0.05），颈椎整体ROM、置换节段FE-COR及ROM、手术相邻节段ROM与术前比较均无统计学差异（P＞0.05）。81个纳入研究的手术相邻节段（上位43个、下位38个）7个节段发生ASD（8.64%），分属于7例患者（7/43，16.28%），1例患者融合节段未获得骨性融合，但处于稳定状态（ROM＜2°），其余患者融合节段均获得骨性融合，未发现与FE-COR横坐标（X）相关的随访指标（|r|＜0.5或P＞0.05），FE-COR纵坐标（Y）与同节段ROM、平移距离呈负相关（r=-0.674，P＜0.05；r=-0.792，P＜0.05），与HSAP呈正相关（r=0.754，P＜0.05），与其他随访指标无显著相关性（|r|＜0.5或P＞0.05）。结论：颈椎前路相邻双节段Hybrid手术患者7年以上随访的临床与影像学结果满意，无证据显示融合节段对置换节段运动功能状态产生明显影响。

英文摘要:

  【Abstract】 Objectives: To observe the clinical and radiological outcomes of mid- to long-term follow-up of anterior cervical Hybrid surgery for the treatment of adjacent two-level cervical spondylosis, and to evaluate the in vivo motor function status of the arthroplasty level with Bryan artificial cervical disc. Methods: A retrospective study was performed on the patients who underwent adjacent two-level anterior cervical Hybrid surgery(Bryan disc for arthroplasty level and MC+cage for fusion level) from July 2010 to December 2013. And a total of 43 patients(23 males and 20 females) each with a range of motion(ROM) >5° at the arthroplasty segment at final follow-up were included, who were averaged 49.1±5.6 years old at the time of surgery. Preoperative symptoms were mainly attributable to myelopathy(26 cases), radiculopathy(6 cases), and myeloradiculopathy(11 cases). The mean follow-up period was 95.43±8.21 months(range, 84-119 months). The clinical outcomes were assessed by the Odom criteria, Japanese Orthopaedic Association(JOA) score, visual analogue scale(VAS), and neck disability index(NDI). The neutral-lateral and flexion-extension cervical radiographs were collected before operation and at final follow-up. The radiological parameters including the ROMs of the overall cervical spine(C2-C7) and the arthroplasty level, flexion and extension-center of rotation(FE-COR) at the arthroplasty level, ROM of adjacent levels, as well as the lordosis angles of the operated level and overall cervical spine(C2-C7) were measured and compared between preoperation and the final follow-up. At final follow-up, adjacent segment degeneration(ASD) and bony fusion at the fusion level were observed, and the translation and the anatomical parameters of zygapophyseal joints were measured at the arthroplasty level, including the height of superior articular process(HSAP), orientation of zygapophyseal joint spaces(OZJS), and the length of superior articular surface(LSAS), and meanwhile correlations between FE-COR and other follow-up data were analyzed. Results: In comparison with preoperative values, the JOA score significantly increased(9.26±3.38 vs 15.21±1.42, P<0.05) with an improvement rate of (80.23±13.80)%, and the NDI, VAS(neck pain), and VAS(arm pain) significantly decreased(34.12±8.96 vs 7.21±4.32, P<0.05; 5.77±2.28 vs 1.72±0.96, P<0.05; 5.26±2.67 vs 1.14±0.83, P<0.05) with improvement rates of (80.03±10.52)%, (69.85±13.44)%, and (78.84±15.89)%, respectively. The excellent or good rate in Odom criteria was 83.72%(excellent, 24 cases; good, 12 cases; satisfactory, 7 cases). The lordosis angles of overall cervical spine and the operated level increased significantly from 14.76°±8.04° and 4.78°±5.86° preoperatively to 20.62°±9.06° and 6.75°± 4.65° at final follow-up, respectively(P<0.05). ROM of the overall cervical spine, FE-COR and ROM at the arthroplasty level, and ROM of adjacent levels at final follow-up showed no significant changes from those before operation(P>0.05). A total of 81 adjacent levels(43 superior levels and 38 inferior levels) were included in the study, and ASD occurred in 7 adjacent levels(7/81, 8.64%) of 7 patients(7/43, 16.28%). At final follow-up, one patient failed to achieve bony fusion at the fusion level, but the state was stable(ROM<2°). The fusion levels of the other patients all met the criteria for bony fusion. At final follow-up, no follow-up data showed at least moderate correlation with abscissa(X) of FE-COR at the arthroplasty level(P>0.05 or |r|<0.5), and ordinate(Y) of FE-COR was negatively correlated with ROM and translation(r=-0.674, P<0.05; r= -0.792, P<0.05) but positively correlated with HSAP(r=0.754, P<0.05) at the arthroplasty level, and moreover, no correlation was found between ordinate(Y) of FE-COR at the arthroplasty level and any other parameters(P>0.05 or |r|<0.5). Conclusions: The clinical and radiological outcomes were satisfactory at least 7 years after the adjacent two-level anterior cervical Hybrid surgery, and there was no evidence that the fusion level had an effect on the motor function status of the arthroplasty level.