人工颈椎间盘置换术治疗C_(3-4)椎间盘突出症的中期疗效研究  

The intermediate clinical outcomes of artificial cervical disc replacement for the treatment of C_(3-4)disc herniation

作　　者：丁琛[1] 洪瑛[1] 龚全[1] 李涛[1] 马立泰[1] 王贝宇[1] 邓宇骁[1] 刘浩[1] 

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《颈腰痛杂志》2016年第1期8-12,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨人工颈椎间盘置换术(artificial cervical disc replacement,ACDR)治疗C_(3-4)椎间盘突出症的中期临床及影像学结果。方法 2010年4月-2014年12月,我院采用ACDR治疗C_(3-4)椎间盘突出症患者9例,含C_(3-4)的双节段椎间盘突出症患者12例;使用Prestige LP人工椎间盘16例,使用Discover人工椎间盘5例;男14例,女7例;年龄35-60岁,平均42.8岁;其中神经根型颈椎病8例,脊髓型7例,混合型6例;术前病程12-60个月,平均27.6个月。分别在术前、术后1周及末次随访时采用生活质量量表(SF-36)、日本矫形外科协会(JOA)脊髓功能评分及颈椎功能障碍指数(NDI)评估临床疗效,在颈椎正侧位X线片上观察假体稳定性并测量C_(3-4)脊柱功能单位(functional spinal unit,FSU)的前凸角,在过伸过屈位X线片上测量C_(3-4)节段屈伸活动度。结果 21例患者术后均获得随访,随访时间6-48个月,平均28.3个月。所有患者术后神经症状均明显改善,SF-36躯体及心理评分、JOA及NDI评分术后1周及末次随访时均明显优于术前(P<0.05)。置入的假体均保留了活动度,无假体沉降或移位。C_(3-4)节段FSU的前凸角与术前相比差异无统计学意义(P>0.05),术后1周时C_(3-4)节段屈伸活动度较术前明显下降(P<0.05),末次随访时恢复到术前水平(P>0.05)。术后4例患者出现咽部不适,2例患者出现C_(3-4)节段周围的异位骨化。结论 C_(3-4)节段人工颈椎间盘置换术后中期临床效果良好,维持了手术节段的生理曲度,且人工椎间盘在C_(3-4)节段仍能保持较好的活动度。Objective To assess the intermediate clinical and radiographic outcomes of artificial cervical disc replacement for the treatment of C3-4 disc herniation. Methods From April 2010 to December 2014, 9 patients underwent single-level replacement because of C3-4 disc herniation and 12 patients underwent bi-level replacement because of C3-4, C4-5（or C3-4） disc herniation in our hospital. Prestige LP discs were applied in 16 patients and Discover discs were applied in 5 patients. There were 14 males and 7 females with an average age of 42.8 years（35-60 years old）. Of them, 8 patients were diagnosed as cervical radiculopathy, 7 patients were diagnosed as cervical myelopathy, and 6 patients were diagnosed as mixed cervial spondylosis. The disease duration was 12-60 months （mean 27.6 months）. The clinical （SF-36 scores, JOA score, NDI score） and radiographic （prostheses stability, lordosis angle and range of motion of C3-4 segment） follow-up examinations were performed preoperatively and at 1 week and last follow-up. Results All patients were followed up for 28.3 months on average （6-48 months）. The neurological symptoms of each patient were obviously alleviated. The SF-36 physical component score and SF-36 mental component score, JOA score and NDI score at 1 week after operation and last follow-up were signif icantly improved compared with the preoperative scores （P〈0.05）. Each prosthesis had a certain range of motion. No subsidence or migration of prosthesis was found. The postoperative lordosis angle of C3-4 FSU showed no statistical significance compared with the preoperative data （P〉0.05）. The C3-4 flexion-extension range of motion decreased significantly from baseline at 1 week follow-up（P〈0.05）, however, it returned to the preoperative level at last follow-up （P〉0.05）. After surgery, 4 patients complained of swallow discomfort, 2 patients had mild heterotopic ossification at C3-4 segment. Conclusion The intermediate follow-up outcomes of patients who underwent artific

关 键 词：颈椎间盘突出症 C3-4节段 颈椎间盘置换术 临床效果 活动度 

分 类 号：R681.55[医药卫生—骨科学]