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刘伟聪,陈雄生,周盛源,苑博,贾连顺.颈人工椎间盘置换治疗单节段颈椎病的中期随访研究[J].脊柱外科杂志,2017,15(2):65-70.
颈人工椎间盘置换治疗单节段颈椎病的中期随访研究     点此下载全文 (Fulltext)
刘伟聪  陈雄生  周盛源  苑博  贾连顺
第二军医大学附属长征医院骨科, 上海 200003
基金项目:
DOI:10.3969/j.issn.1672-2957.2017.02.001
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摘要:
      目的 观察颈人工椎间盘置换术(CTDR)治疗单节段颈椎病的中期临床疗效。方法 回顾性分析2009 年1月-2011年10月本院收治的随访> 4年的81例单节段退变性颈椎病患者临床资料,按照手术方式分为CTDR组(n=41)及颈椎前路椎间盘切除减压融合术(ACDF)组(n=40)。采用颈椎功能障碍指数(NDI)和日本骨科学会(JOA)评分进行功能评价,采用McAfee 分级评定异位骨化情况,并进行组间比较。通过MRI 进行影像学评估,比较2 组手术节段、邻近节段活动度(ROM)和C2-7 Cobb 角。结果 两组患者术后NDI 和JOA评分明显改善。术后1 个月CTDR组NDI 明显高于ACDF 组,在工作、驾车和娱乐3 个项目上差异均有统计学意义(P< 0.05),两组之间JOA评分改善差异无统计学意义(P>0.05)。在上、下邻近节段ROM和C2-7 Cobb 角方面,CTDR组术前、术后变化不明显;ACDF 组上位邻近节段ROM术后明显增加,C2-7 Cobb 角术后明显减小,与术前相比差异均有统计学意义(P< 0.05);CTDR组与ACDF 组相比,术后上位邻近节段ROM及C2-7 Cobb 角差异有统计学意义(P< 0.05)。CTDR组在末次随访时共有15 例患者出现异位骨化,2 例假体下沉,1 例椎体前缘骨赘吸收。ACDF 组无椎间融合器下沉、植骨不愈合、畸形愈合、内固定松动断裂等并发症发生。结论 CTDR在早期恢复独立生活能力方面优势明显,中期随访可较好维持颈椎生理曲度及置换节段ROM,减少相邻节段的异常活动,保护邻近椎间盘,但中期随访发现有异位骨化发生。
关键词:颈椎病  椎间盘  假体植入
Cervical total disc replacement for treatment of single level cervical disc degenerative disease: midterm follow-up results    Fulltext
LIU Wei-cong  CHEN Xiong-sheng  ZHOU Sheng-yuan  YUAN Bo  JIA Lian-shun
Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Fund Project:
Abstract:
      Objective To observe the mid-term clinical efficacy of cervical total disc replacement(CTDR) in the treatment of single level cervical disc degenerative disease. Methods From January 2009 to October 2011, the clinical data of 81 patients with single level cervical disc degenerative disease and followed up more than 4 years were retrospectively analyzed. The patients were divided into CTDR group(n=41) and anterior cervical discectomy and fusion(ACDF) group(n=40). The Japanese Orthopaedic Association(JOA) score and the neck disability index(NDI) were used to evaluate improvement of the functional status; McAfee classification was used to evaluate the heterotopic ossification; and the differences between the 2 groups were compared. Imaging evaluation was performed by MRI, and the operative and adjacent segments' range of motion (ROM) and C2-7 Cobb's angle were compared between the 2 groups. Results The postoperative JOA scores and NDI were significantly improved in both groups. At postoperative 1 month, the NDI of CTDR group was significantly better than that of ACDF group, especially in the items such as work, driving and recreation, and the difference was statistically significant(P< 0.05). There was no significant difference in JOA scores between the 2 groups. The change in ROM of upper and lower adjacent segments and C2-7 Cobb's angle was not obvious in CTDR group. The change in ROM of upper adjacent segments and C2-7 Cobb's angle was obvious in ACDF group, and the difference was statistically significant(P< 0.05). The differences in postoperative ROM of upper adjacent segments and C2-7 Cobb's angle were statistically significant between the CTDR group and ACDF group (P< 0.05). In CTDR group, there were 15 cases of heterotopic ossification, 2 prosthesis sinking, and 1 case of resorption of vertebral anterior edge osteopgytes at the final follow-up. In ACDF group, there were no complications such as subsidence of interbody fusion cage, nonunion, malunion and loosening of internal fixation. Conclusion CTDR is an effective choice in the treatment of single level cervical disc degenerative diseasebecause of its significant superior effect in improving the early capacity of independent living. It also facilitates the restoration of cervical segmental motion and cervical sagittal alignment despite radiographic evidence of heterotopic ossification at mid-term follow-up period.
Keywords:Cervical spondylosis  Intervertebral disc  Prosthesis implantation
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