人工椎间盘置换联合锚定式颈椎融合器治疗多节段颈椎间盘突出症的临床观察  

Clinical outcome of artificial cervical disc arthroplasty combined with anchoring cervical intervertebral fusion cage for the treatment of multilevel cervical disc herniation Chen

作　　者：陈道振[1] 高坤[2] 赵志坚[1] 陈坤峰[1] 高延征[2] 

机构地区：[1]河南省商丘市第一人民医院创伤外科,476100 [2]河南省人民医院脊柱外科

出　　处：《中国医师进修杂志》2015年第9期652-655,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨颈前路减压人工椎间盘置换联合锚定式颈椎融合器治疗多节段颈椎间盘突出症的临床疗效。方法2011年10月至2013年9月手术治疗多节段颈椎间盘突出症患者26例，男10例，女16例，年龄32-60岁，平均46．8岁；受累2个节段15例，3个节段11例。均一期行颈前路减压人工椎间盘置换联合锚定式颈椎融合器治疗。术前、术后采用日本矫形外科协会（JOA）评分（17分法）及颈椎残障功能指数（NDI）进行评价，随访观察假体稳定性、置换节段活动度和植骨融合情况等。结果26例患者手术时间为（95±15）min，出血量为（100±20）ml。随访6～20个月，平均15个月。末次随访时JOA评分由术前（9．08±1．72）分增加至（14．88±1．37）分，NDI评分由术前（40．31±4．97）分降至（25．23±4．10）分，差异均有统计学意义（P〈0．05）；手术前后置换节段颈椎总活动度比较差异无统计学意义（P〉0．05）。融合节段均顺利融合，无切口感染、脑脊液漏、邻近节段椎间盘退变、假体移位等并发症发生。结论颈前路减压人工椎间盘置换联合锚定式颈椎融合器治疗多节段颈椎间盘突出症，能够减少融合节段，降低长节段融合后邻近节段的应力，近期临床效果良好。Objective To evaluate the clinical outcome of artificial cervical disc arthroplasty combined with anchoring cervical intervertebral fusion cage （ACIFC） in the treatment of multilevel cervical disc herniation. Methods From October 2011 to September 2013, 0.26 patients with multilevel cervical disc herniation underwent artificial cervical disc arthroplasty combined with ACIFC, there were 10 male and 16 female with age from 32 to 60 years （mean 46.8 years）. Two segment were involved in 15 patients, three segment were involved in 11 patients. Neck disability index （NDI） and Japanese Orthopaedic Association （JOA） score were used to evaluate neurofunctiona] recovery preoperatively and postoperatively. The postoperative stabilization and the range of motion （ROM） of implanted disc and the fusion of cage were observed on dynamic radiograph. Results The average operation time and amount of bleeding were （95 ± 15） min and （100 ± 20） ml respectively. The average postoperative follow-up was 15 months（range 6 - 20 months）. At the end of follow up,the scores of JOA was increased and the scores of NDI was decreased： （9.08 ± 1.72） scores vs. （14.88 ± 1.37） scores, （40.31 ±4.97） scores vs. （25.23±4.10） scores,there had significant differences （P 〈 0.05）. The change of ROM had no significant difference （P 〉 0.05）. Solid fusion was achieved in all levels brought by cage. There was no cage subsidence or displacement. All artificial cervical disc achieved definite stabilization, no intraoperative and postoperative complication was noted. Conclusions Artificial cervical disc arthroplasty combined with ACIFC provides a feasible way for the treatment of multilevel cervical disc herniation. The definite stabilization and maintained ROM can reduce the fusion segments and avoid the increased stress of adjacent segment which can ensure a good preliminary clinical outcome.

关 键 词：椎间盘移位 锚定式颈椎融合器 椎间盘假体 

分 类 号：R687.3[医药卫生—骨科学]