| 宋卿鹏,田伟,何达,等.颈椎人工间盘置换术治疗混合型颈椎病的长期疗效观察.骨科,2018,9(4): 253-259. |
| 颈椎人工间盘置换术治疗混合型颈椎病的长期疗效观察 |
| Long-term efficacy of cervical artificial disc replacement for the treatment of myeloradiculopathy |
| 投稿时间：2018-01-26 |
| DOI：10.3969/j.issn.1674-8573.2018.04.001 |
| 中文关键词: 颈椎 全椎间盘置换 混合型颈椎病 长期随访研究 |
| 英文关键词: Cervical vertebrae Total disc replacement Myeloradiculopathy Long-term follow-up studies |
| 基金项目:北京市医院管理局青年人才培养“青苗”计划（QML20160402）；北京市科学技术委员会专项经费（Z161100000516134）；北京市医院管理局“使命”人才计划（SML20150401） |
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| 中文摘要: |
| 目的 评估颈椎人工间盘置换术（cervical artificial disc replacement, CADR）治疗混合型颈椎病的长期临床疗效并探讨其影响因素。方法 对2003年12月至2007年12月于我院行单节段CADR治疗混合型颈椎病的25例病人进行回顾性分析，病人年龄为（56.56±8.65）岁，其中男15例，女10例，随访时间均在10年以上。依据术前CT及MRI检查结果将病人分为单纯间盘突出组（7例）、合并骨赘增生组（18例）。收集并比较两组病人手术前后的颈椎整体活动度、手术节段活动度、手术节段Cobb角、椎旁骨化（paravertebral ossification, PO）分级、日本骨科协会（Japanese Orthopaedic Association, JOA）评估治疗分数、颈椎功能障碍指数（neck disability index, NDI）及Odom's标准。结果 单纯间盘突出组病人术前及末次随访时的手术节段活动度分别为9.61°±4.72°、12.63°±4.41°，颈椎整体活动度分别为50.91°±15.58°、57.62°±9.18°，手术节段Cobb角分别为2.61°±1.38°、2.07±1.74°，末次随访时未发生高等级PO，手术前后的各指标比较，差异均无统计学意义。合并骨赘增生组术前及末次随访时的手术节段活动度分别为9.73°±4.62°、7.77°±5.82°，颈椎整体活动度分别为45.98°±17.26°、40.89°±15.85°，手术节段Cobb角分别为1.92°±1.11°、0.69°±2.12°，高等级PO发生率为55.6%，末次随访时的手术节段Cobb角较术前明显下降，差异有统计学意义（P=0.004）。末次随访时，合并骨赘增生组颈椎整体活动度低于单纯间盘突出组（t=2.610，P=0.016），高等级PO比例较单纯间盘突出组更高（Z=2.494，P=0.034），其余各影像学评估指标的组间比较，差异均无统计学意义。两组病人末次随访时JOA评分及NDI均较术前明显改善（P均＜0.05），单纯间盘突出组NDI下降情况优于合并骨赘组（t=2.169，P=0.041），其余各临床功能评估指标的组间差异无统计学意义。结论 采用CADR治疗混合型颈椎病，长期临床疗效好，且对于单纯颈椎间盘突出病人的疗效优于合并骨赘增生的病人。 |
| 英文摘要: |
| Objective To evaluated the long-term efficacy of cervical artificial disc replacement (CADR) for the treatment of myeloradiculopathy and analyze the influencing factors of the long-term outcomes. Methods The clinical data of 25 patients undergoing single-level Bryan cervical artificial disc replacement for treating myeloradiculopathy from December 2003 to December 2007 in our hospital were retrospectively analyzed, and all patients were followed up for at least 10 years. The age of patients was 56.56±8.65 years, including 15 men and 10 women. According to preoperative CT and MRI examinations, patients were divided into two groups: 7 patients in disc herniation group and 18 patients in osteophytes group. The radiographic evaluation indexes including global range of motion (ROM), segmental ROM, segmental Cobb angel and paravertebral ossification (PO) grade and the clinical evaluation indexes including Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom's criteria were recorded at baseline and at last follow-up. The difference in the baseline and the last follow-up in each group and that between two groups were analyzed. Results In disc herniation group, the segmental ROM was 9.61°±4.72° at baseline and 12.63°±4.41° at last follow-up, global ROM was 50.91°±15.58° at baseline and 57.62°±9.18° at last follow-up, segmental Cobb angle was 2.61°±1.38° at baseline and 2.07°±1.74° at last follow-up. At last follow-up, no patients developed high grade PO. There was no significant difference between the baseline and the last follow-up. In osteophytes group, the segmental ROM was 9.73°±4.62° at baseline and 7.77°±5.82° at last follow-up, global ROM was 45.98°±17.26° at baseline and 40.89°±15.85° at last follow-up, segmental Cobb angle was 1.92°±1.11° at baseline and 0.69°±2.12° at last follow-up. At last follow-up, 55.6% of patients developed high grade PO, and segmental Cobb angle was significantly decreased (P=0.004). At last follow-up, the global ROM and the PO grade in disc herniation group were significantly better than those in osteophytes group (t=2.610, P=0.016; Z=2.494, P=0.034). The JOA score and NDI were significantly improved in both two groups (P＜0.05 for all). NDI was significantly declined in disc herniation group as compared with osteophytes group (t=2.169, P=0.041). The rest clinical evaluation indexes had no significant difference between two groups. Conclusion CADR gained favorable long-term outcomes in the treatment of myeloradiculopathy, and the long-term efficacy in patients caused by disc herniation was better than in those caused by osteophytes. |
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