祁 敏,陈华江,王新伟,刘 洋,曹 鹏,田 野,沈晓龙,袁 文.人工颈椎间盘置换术治疗颈椎病的中长期临床疗效[J].中国脊柱脊髓杂志,2020,(12):1062-1069.
人工颈椎间盘置换术治疗颈椎病的中长期临床疗效
中文关键词:  颈椎病  人工颈椎间盘置换术  中长期随访  临床疗效
中文摘要:
  【摘要】 目的:回顾性分析人工颈椎间盘置换术(artificial cervical disc replacement,ACDR)治疗颈椎病的中长期临床疗效及并发症发生情况。方法:2009年5月~2015年5月在我科接受ACDR治疗的68例颈椎病患者纳入本研究。其中男性32例,女性36例;年龄39.1±6.2岁(23~55岁)。脊髓型颈椎病42例,神经根型颈椎病19例,混合型颈椎病7例。术前病程9.5~21.5个月(14.5±6.3个月)。52例接受单节段ACDR,16例接受两节段ACDR。人工椎间盘为Discover假体。采用日本矫形外科学会(Japan Orthopedic Association,JOA)评分法、疼痛视觉模拟评分法(visual analogue scale/score,VAS)和颈椎功能障碍指数(neck disability index,NDI)对患者的神经功能和临床症状情况进行评估;术前、术后及末次随访时采用颈椎X线片评估患者颈椎曲度(C2-C7 Cobb角),采用颈椎过屈过伸位X线片测量手术节段的活动度,在侧位X线片上观察手术节段的邻近节段骨赘形成情况,采用骨赘形成分级判断邻近节段的退变情况。末次随访时采用颈椎CT平扫+三维重建和McAfee分级法评估手术节段异位骨化(heterotopic ossification,HO)情况。记录患者术后轴性症状等并发症发生情况。结果:随访78~132个月(98.3±17.2个月),随访期间JOA评分、VAS评分和NDI均获得了良好改善,末次随访时与术前比较均有显著性差异(P<0.05)。术后第二天,纳入患者的颈椎曲度与术前比较有统计学差异(12.5°±3.9° vs 9.3°±5.5°, P=0.044),末次随访时的颈椎曲度与术前比较无统计学差异(10.3°±4.2° vs 9.3°±5.5°,P=0.181)。手术节段的活动度术前为6.5°±3.4°,术后第2天为8.7°±2.8°(P=0.001),术后1年随访时为8.2°±3.8°,术后2年随访时为7.5°±4.1°,术后5年随访时为5.3°±4.8°,末次随访时为4.5°±2.7°,末次随访时与术前和术后1年时比较均明显降低(P=0.021,P=0.019)。末次随访时头侧和尾侧相邻节段骨赘形成分级分别加重0.46和0.41级。术后1年随访时轴性症状发生率为4.41%(单节段组2例、两节段组1例),术后5年以后随访无颈部疼痛等主诉。末次随访时有46例(67.65%)患者、51个(60.71%)手术节段发生不同程度的HO,两节段组患者HO的发生率明显高于单节段组患者(81.25% vs 63.46%,P=0.048)。结论:ACDR治疗颈椎病具有较好的中长期临床疗效,但伴随随访时间延长HO发生率趋于增加,且并未明显获得防止邻近节段退变的优势。
Medium and long term clinical outcomes of artificial cervical disc replacement
英文关键词:Cervical spondylosis  Artificial cervical disc replacement  Medium and long-term follow-up  Clinical efficacy
英文摘要:
  【Abstract】 Objectives: To retrospectively analyze the mid- and long-term clinical outcomes and complica?鄄tions of artificial cervical disc replacement(ACDR) in cervical spondylosis. Methods: A total of 68 patients with cervical spondylosis who received ACDR treatment in our department from May 2009 to May 2015 were included in this study. Among them, 32 cases were males and 36 cases were females; the average age was 39.1±6.2 years(23-55 years). There were 42 cases of cervical spondylotic myelopathy, 19 cases of nerve root type cervical spondylosis, and 7 cases of mixed cervical spondylopathy. The preoperative course of disease was 9.5 to 21.5 months(14.5±6.3 months). 52 patients received single-segment ACDR and 16 patients re?鄄ceived two-segment ACDR. The artificial disc was a Discover prosthesis. The Japan Orthopedic Association(JOA) score, the pain visual analogue scale(VAS) score, and the cervical disability index(neck disability index, NDI) were used to assess the patient′s neurological function and clinical symptoms; cervical spine X-rays were used to assess the patient′s cervical curvature(C2-C7 Cobb angle) before operation, after operation and final follow-up. The range of motion of the operative segment was measured by X-ray of cervical hyperflexion and extension. The osteophyte formation in the adjacent segment was observed on the lateral X-ray films. The osteophyte formation grade was used to judge the degeneration of the adjacent segment. Cervical CT plain scan + three-dimensional reconstruction and McAfee classification method were used to evaluate the hetero?鄄topic ossification(HO) of the surgical segment. The postoperative axial symptoms and other complications were recorded. Results: The follow-up period was 78 to 132 months(averaged 98.3±17.2 months). During the follow-up period, neurological function and clinical symptoms were improved. On the second day after surgery, the cervical curvature of the included patients was significantly improved than that before surgery(12.5°±3.9° vs 9.3°±5.5°, P=0.044). At final follow-up, the cervical spine curvature(C2-C7 Cobb angle) was not significantly different from that before surgery(10.3°±4.2° vs 9.3°±5.5°, P=0.181). The range of motion increased from 6.5°±3.4° before surgery to 8.7°±2.8° on the second day after surgery(P=0.001), 8.2°±3.8° at 1 year follow-up, 7.5°±4.1° at 2 years follow-up, and 5.3°±4.8° at the 5-year follow-up. At final follow-up, the range of motion of the surgical segment was 4.5°±2.7°, which was significantly lower than that before operation and 1 year after operation(P=0.021, P=0.019). At final follow-up, the grades of osteophyte formation in adjacent segments on the cephalic and caudal sides increased by 0.46 and 0.41 respectively. The incidence of axial symptoms dropped to 4.41% during follow-up after 1 year(2 cases in the single-segment group and 1 case in the two-segment group). 5 years after the operation, the patients had no complaints of neck pain. At final follow-up, 46 patients(67.65%) with 51(60.71%) surgical segments had varying degrees of HO manifestations. The incidence of HO in two segment group was significantly higher than that in single segment group(81.25% vs 63.46%, P=0.048). Conclusions: ACDR has a good mid- to long-term clinical effect in cervical spondylosis, but postoperative complications such as HO cannot be ignored. Its protective effect on the degeneration of adjacent segments needs further observation and follow-up.
投稿时间:2020-08-22  修订日期:2020-10-09
DOI:
基金项目:海军军医大学校级青年启动基金(2018QN14),长征医院金字塔人才工程
作者单位
祁 敏 海军军医大学长征医院脊柱一科 200003 上海市 
陈华江 海军军医大学长征医院脊柱一科 200003 上海市 
王新伟 海军军医大学长征医院脊柱一科 200003 上海市 
刘 洋  
曹 鹏  
田 野  
沈晓龙  
袁 文  
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