颈人工椎间盘置换近期并发症分析  

Analysis of early complications of Bryan cervical disc arthroplasty

作　　者：杨大龙[1] 申勇[1] 曹俊明[1] 董玉昌[1] 孟宪国[1] 丁文元[1] 姚晓光[1] 孟宪中[1] 张为[1] 李宝俊[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄市050051

出　　处：《中国脊柱脊髓杂志》2008年第4期249-252,共4页Chinese Journal of Spine and Spinal Cord

基　　金：河北省科学技术研究与发展计划项目(0624611135D-1)

摘　　要：目的:分析颈人工椎间盘置换术的近期并发症及其原因。方法:2004年10月至2007年1月,对30例患者的33个节段进行了Bryan颈人工椎间盘置换术,男13例,女17例,年龄33～54岁,平均43.3岁,统计并发症发生的情况,并分析其发生的原因。结果:2例发生喉上和喉返神经损伤,可能与术中过度牵拉有关,术后1个月自行恢复;1例颈部切口血肿形成,可能与术中止血不彻底有关,经颈部伤口引流、抗感染等处理后痊愈;1例神经根型患者术后根性疼痛缓解不明显,可能与术中减压不彻底有关,患者拒绝再次手术,给予保守治疗效果不佳。全部病例随访9个月～2年,平均15.6个月,脊髓型颈椎病患者术前JOA评分为8.34±1.22分,末次随访时为16.11±1.01分,与术前比较差异有显著性(P<0.01)。1例术后1年随访时发现假体周围异位骨化形成,2年随访时出现自发融合,原因不明;2例术后置换节段后凸,可能与术后椎间高度的丢失及椎间角度的改变有关,患者无临床症状,未予处理。结论:颈人工椎间盘置换治疗颈椎间盘疾患可取得较好的临床疗效,但手术操作复杂,有其特有的并发症,应重视手术适应证的选择及严格手术操作规范。Objective：To explore the cause of the early complications of Bryan cervical disc arthroplasty and summarize the prevention experience.Method：From October 2004 to January 2007,30 patients （13 males and 17 females） with 33 levels underwent Bryan cervical disc placement.The average age was 43.3 years（range, 33-54 years）.The number and type of all complications were analyzed.Result：Complications occurred in 7 patients.Two eases of transient laryngeal nerve or superior laryngeal nerve injury resulted from excessively stretching and recovered in 1 month without any interference.One ease with cervical hematoma associated with inadequate blood control was treated by antibiotics with drainage ,and achieved good outcome.One ease complained of persistent arm pain because of incomplete decompression and was treated by dehydration,but the pain was still present.The average period of follow-up was 15.6 months.JOA scores were improved from 8.34± 1.22 points to 16.11±1.01 points （P〈0.01）.One case showed heterotopie ossification in 1 year and developed spontaneous fusion in 2 years after operation.Two eases had the segmental kyphotie change after surgery because of the changes of intervertebral height and angle.Conclusion：The Byran disc arthroplasty for cervical spondylosis can get good clinical outcomes,but the procedure is much complicated and has its special com- plications,so the surgical indications and correct manipulations should be chosen properly.

关 键 词：颈人工椎间盘 颈椎病 置换 并发症 

分 类 号：R681.5[医药卫生—骨科学] R619[医药卫生—外科学]