双节段人工椎间盘置换加融合在多节段颈椎间盘突出症的应用  

TWO-LEVEL CERVICAL ARTIFICIAL DISC REPLACEMENT COMBINED WITH NEARBY SEGMENTS FUSED FOR MULTI-LEVEL DISC HERNIATIONS

作　　者：刘浩[1] 刘熹[1] 石锐[1] 龚民[1] 赵小丹[1] 张箭[1] 张闻力[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2006年第4期383-386,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 总结1例多节段颈椎间盘突出症患者相邻颈椎节段实施人工椎间盘置换和植骨融合的效果，以及二者间的相互影响，为多节段椎间盘突出症寻找新的外科治疗方法。方法2004年12月对确诊为C3～7椎间盘突出症的患者，实施C4～6椎间盘置换术，C3,4及C6、7椎间盘切除，椎体间行钛网植骨、Zephir钢板内固定术。术后2d下床行颈椎功能锻炼，术后3周～3个月颈椎支具制动。以术后动力位X线片衡量其颈椎活动范围。结果术后患者颈椎活动时无疼痛，脊髓神经症状有所缓解。获随访1年2个月，颈椎活动无明显受限，四肢感觉、肌力正常。动力位X线片可见颈椎前屈、后伸和左右侧弯活动范围均接近正常水平。结论人工椎间盘置换结合植骨融合治疗多节段颈椎间盘突出症，近期临床效果较好；术后早期加强颈椎功能锻炼，再限制颈椎活动，可较好地处理术后活动和制动的矛盾，达到手术目的。Objective To evaluate the therapeutic effect of the two-level cervical artificial disc replacements combined with the nearby segments fused for the multi-level disc herniations and to investigate their interaction during the treatment. Methods The patient undergoing surgery was diagnosed as having intervertebral disc herniations in the C3-7 intervertebral discs. During the operation, the C4-6 discs were replaced with two Bryan artificial discs while the C3,4 and C6,7 discs were removed, followed by the bone grafting and the Zephir instrumentation. The range of motion （ROM） was assessed before and immediately after operation by the flexion-extension radiography. The patient＇s functional exercise began as early as 2 days after operation and lasted for 3 weeks, followed by immobilization for 3 months. Results According to the follow-up for 1 year and 2 months, the patient could move his neck in all directions without pain. The spinal and neural symptoms were significantly alleviated. ROM was close to the normal level postoperatively. Conclusion Artificial disc replacement combined with bone grafting and fusion is a new way to treat multi-level disc herniations surgically, with good clinical results. Early cervical functional exercise followed by restriction is an effective way to deal with the contradiction of motion and immobilization.

关 键 词：颈椎间盘突出症 人工椎间盘置换 融合术 

分 类 号：R687.3[医药卫生—骨科学]