人工颈椎间盘置换术与颈椎前路减压融合术对相邻节段退变的影响  

EFFECT OF CERVICAL DISC ARTHROPLASTY AND ANTERIOR CERVICAL DECOMPRESSION AND FUSION ON ADJACENT SEGMENT DEGENERATION

作　　者：关涛[1] 胡志伏 修磊[1] 李楠[1] 金群华[2] 

机构地区：[1]宁夏医科大学临床学院,银川750004 [2]宁夏医科大学总医院骨三科

出　　处：《中国修复重建外科杂志》2014年第9期1100-1105,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较人工颈椎间盘置换术（cervicaldiscarthroplasty，CDA）与颈椎前路减压融合术（anteriorcervicaldecompressionandfusion，ACDF）对相邻节段退变的影响。方法2009年8月-2012年2月共60例颈椎病患者符合选择标准纳入研究，根据术式不同分为CDA组（28例）和ACDF组（32例）。两组患者性别、年龄、病程、病变类型、病变节段、保守治疗时间以及术前颈椎功能障碍指数（NDI）、日本骨科协会（JOA）评分、相邻上下节段活动度（rangeofmotion，ROM）、颈椎退变及椎间盘退变程度比较，差异均无统计学意义（P〉0．05），具有可比性。术后以NDI和JOA评分评价两组疗效；摄颈椎过伸、过屈位X线片和颈椎MRI，比较相邻上、下节段ROM及颈椎、椎间盘退变程度。结果两组患者均获随访，随访时间24～50个月，平均34个月。无假体移位、松动及钢板断裂等并发症发生。两组术后12、24个月及末次随访时NDI及JOA评分均较术前显著改善（P〈0．05），术后各时间点两组间NDI及JOA评分比较差异均无统计学意义（P〉0．05）。ACDF组和CDA组末次随访时JOA改善率分别为80．68％±4．01％和79．44％±3．76％，差异无统计学意义（t=1．237，P=-0．221）；两组JOA改善率均达优。末次随访时，两组相邻上、下节段ROM、KellgrenX线颈椎退变分级与术前比较及两组间比较，差异均无统计学意义（P〉0．05）。末次随访时，两组Miyazaki颈椎间盘退变分级与术前比较差异均有统计学意义（P〈0．05），但两组间比较差异无统计学意义（Z=0．132，P=-0．895）。结论CDA和ACDF治疗脊髓型及神经根型颈椎病均能获良好疗效，但CDA不能明显减缓相邻节段椎间盘的退变。Objective To compare the effect on adjacent segment degeneration after cervical disc arthroplasty （CDA） and anterior cervical decompression and fusion （ACDF） for treatment of cervical spondylosis. Methods Between August 2009 and February 2012, 60 cases of single segmental cervical spondylosis accorded with the inclusion criteria were included. Of 60 patients, 28 patients underwent CDA （CDA group） and 32 patients underwent ACDF （ACDF group）. There was no significant difference in gender, age, disease duration, pathological type, pathological segment, the time of conservation treatment, preoperative neck disability index （NDI）, preoperative Japanese Orthopaedic Association （JOA） score, and degeneration of the adjacent segment and disc between 2 groups （P 〉 0.05）. The NDI and JOA score were used to evaluate effectiveness. The range of motion （ROM） of adjacent segment was measured, and degeneration of the adjacent segment and disc was evaluated according to Kellgren grading system based on X-ray and Miyazaki grading system based on T2-weighted MRI, respectively. Results The follow-up time was 24-50 months （mean, 34 months） in 2 groups. All patients had no complication of prosthesis loosening, dislocation, or fracture of plate. The NDI and JOA scores from 12 months after operation were significantly improved compared with preoperative scores in 2 groups （P 〈 0.05）, but no significant difference was found at each time point between 2 groups （P 〉 0.05）. The improvement rate of JOA was 80.68%± 4.01% in ACDF group and was 79.44% ± 3.76% in CDA group at last follow-up, showing no significant difference （t= 1.237, P=0.221）. And the improvement rate of JOA in 2 groups were excellent. There was no significant difference in ROM and degeneration grading of adjacent segments between at last follow-up and at pre-operation in 2 groups （P 〉 0.05）, and between 2 groups at pre-operation and at last follow-up （P 〉 0.05）. The degeneration grading of disc at last follow

关 键 词：颈椎前路减压融合术 人工颈椎间盘置换术 相邻节段退变 

分 类 号：R687.3[医药卫生—骨科学]