同种异体颈椎间盘移植术后影像学变化及临床疗效观察  

The clinical outcome and radiographic changes following cervical disc allografting

作　　者：丁宇[1] 阮狄克[1] 何勍[1] 

机构地区：[1]海军总医院骨科,北京100048

出　　处：《转化医学杂志》2012年第3期154-157,160,共5页Translational Medicine Journal

摘　　要：目的评价颈椎间盘移植术后中远期影像学变化及临床疗效,探讨颈椎曲度及脊髓面积变化的临床意义。方法收集13例相关资料,平均随访6.1年,比较手术前后神经功能及影像学变化。结果①颈椎手术前后神经功能评分差异有统计学意义(P=0.01),退变病例神经功能改善率为(67.5±27.2)%,创伤病例有1～2个Frankel级别改善;另外,患者术后颈部轴性症状视觉模拟评分没有明显变化(P>0.05)。②术后颈椎整体曲度及手术节段曲度维持满意,颈椎活动度无明显变化。③术后病变节段脊髓横截面积明显增加,由(112.7±20.5)mm2增至(172.2±29.6)mm2;而移植椎间盘髓核灰度值则有明显降低,由0.36±0.17减至0.21±0.15;上下相邻节段椎间盘内髓核灰度值由术后即刻0.33±0.15降至随访时0.30±0.12,但差异没有统计学意义(P=0.19)。结论①异体颈椎间盘移植术后疗效满意,重建了颈椎稳定性及生理功能,安全可靠。②虽然中长期随访移植椎间盘发生了不同程度的退变,但影像学显示术后椎间盘可以存活,有效维持并改善了颈椎的生物学性能。Objective To assess the mid-and long-term outcome and radiographic character following total disc allografting （TDA）, and furthermore, to explore the significance of changes of the spinal curvature and spinal cord area. Methods The data of 13 cases were collected, of which the average follow-up time was 6.1-year. The neurological function and radiologic changes before and after the transplantation were compared and analyzed. Results ①There was a significant im- provement of the neurological function after disc allografting （ P = 0. 01 ）, with （ 67.5±27.2 ） % ameliorated in the disc degenerative cases. In the traumatic cases, the there were also 1-2 Frankel rank improved. Postoperatively, the VAS score of axial symptoms （AS） did not increase significantly（P〉0.05 ）.②Both the entire and local segment maintained a satisfied curve after allografting. Besides, the motion of the cervical spine did not change postoperatively.③Postoperatively, the spinal cord area at the index level increased significantly, from （ 112.7±20. 5） mm2 to （172.2±29.6） mm2. While the signal value of the transplanted disc decreased sharply, from 0. 36±0.17 to 0.21±0. 15. Similiar to the gray value of in tradiscal nuelens pulposus around upper and lower adjacent segments, decreased from 0. 33±0. 15 to 0.30±0. 12. However, there was no statistics difference. Conclusion ①TDA has the satisfied clinical outcome combining with segmental mobility and sta-bility. ②Although there occur somewhat degeneration in the transplanted disc, the allograft can still be alive and successfully maintain and improve the biological characters of the cervical spine.

关 键 词：颈椎 椎间盘移植 影像学 临床疗效 轴性症状 

分 类 号：R681.5[医药卫生—骨科学]