颈椎间盘置换术治疗伴交感神经症状颈椎病的早期疗效  

Total disc replacement to treat cervical spondylotic myelopathy with sympathetic symptoms

作　　者：梁磊[1] 王新伟[1] 袁文[1] 李君[1] 陈华江[1] 祁敏[1] 王占超[1] 

机构地区：[1]第二军医大学附属长征医院脊柱外科,上海200003

出　　处：《中华骨科杂志》2012年第5期389-392,共4页Chinese Journal of Orthopaedics

基　　金：上海市科学技术委员会科研计划项目课题重大项目（10DZ1950500）;上海市科技人才计划项目（10XD1405700）

摘　　要：目的探讨颈椎间盘置换术治疗伴交感神经症状颈椎病的临床有效性。方法回顾性分析2008年10月至2011年5月收治的27例伴交感神经症状颈椎病患者。使用Prestige或Discover人工椎间盘假体行单节段颈椎间盘置换术，术中彻底去除减压节段后纵韧带。全部病例随访至少6个月，平均15．1个月。统计并分析患者术前、术后1周、术后2个月及末次随访时交感神经症状改善情况、日本整形外科学会（Japanese Orthopedic Association，JOA）评分、健康调查简易量表（The Short Form-36，SF-36）评分及人工椎间盘假体稳定性。交感神经症状采用“20分评分法”评定。结果所有患者术后交感神经症状评分均明显改善：术前为（8．5±2．5）分，术后1周为（1．6±1．4）分，末次随访时为（2.3±1．1）分。患者主观满意度：优15例，良8例，可4例，优良率为85．2％。JOA评分：术前为（10．8＋2．4）分，术后1周为（11．1±2．5）分，末次随访时为（14．9±1．4）分；SF-36评分：术前为（102．7±8．7）分，末次随访时为（129．8±5．5）分，较术前均明显改善（P〈0．05）。影像学检查提示：手术节段颈椎活动度得到保留（术前活动度为7.3°±2．7°，术后为7．7°±3．2°）。全部假体位置稳定，未见松动、移位。结论应用颈椎间盘置换术治疗伴交感神经症状颈椎病早期效果良好，术中彻底去除致压节段的后纵韧带可能是预后良好的关键因素。Objective To investigate the effect of total disc replacement （TDR） in the treatment of cervical spondylotic myelopathy （CSM） with sympathetic symptoms. Methods Twenty-seven patients （15 males and 12 females） with CSM at single level accompanied by sympathetic symptoms, who underwent TDR surgery（Prestige or Discover prosthesis） with the posterior longitudinal ligament （PLL） resected at the area of decompression between October 2008 and May 2011, were retrospectively analyzed. All patients were followed up for at least 6 months （average, 15.1 months）. Clinical and radiologic evaluations were obtained pre- operatively, 1 week postoperatively, and at the final follow-up. The sympathetic symptoms were scored by our original 20-point system. The clinical outcomes were assessed by Japanese Orthopedic Association （JOA） scoring system and the Short Form-36 Health Survey （SF-36）. Results The sympathetic symptoms were im- proved in all patients and the score was significantly improved after surgery. The sympathetic symptoms scores were （8.5±2.5） points preoperatively, （1.6±1.4） points 1 week postoperatively, and （2.3±1.1） points at the final follow-up. The patient＇s subjective satisfaction was excellent in 15 patients, good in 8, fair in 4, with an excellent and good rate of 85.2%. The corresponding JOA scores were （10.8±2.4） points, （11.1±2.5） points, and （14.9±1.4） points, respectively. The SF-36 scores showed statistical improvements from preoperative （102.7±8.7） points to postoperative （129.8±5.5） points. Based on X-ray examination, the range of motion of the treated segment were reserved. During the follow-up period, there was no prosthesis subsidence or excursion. Conclusion The CSM patients with sympathetic symptoms could be managed successfully with TDR. And thoroughly resection of the PLL may be the key factor for good prognosis.

关 键 词：颈椎病 自主神经系统疾病 关节成形术 置换 

分 类 号：R687.3[医药卫生—骨科学]