人工间盘尺寸大小对颈椎人工间盘置换效果的影响  

Influence of the artificial disc size on cervical artificial disc replacement

作　　者：宋卿鹏 田伟[1] 何达[1] 韩骁[1] 王晋超[1] 李祖昌 冯啸 Song Qing-peng;Tian Wei;He Da;Han Xiao;Wang Jin-chao;Li Zu-chang;Feng Xiao(Department of Spine Surgery,Beijing Jishuitan Hospital,Fourth Clinical Medical College of Peking University,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京大学第四临床医学院,北京市100035

出　　处：《中国组织工程研究》2018年第11期1665-1670,共6页Chinese Journal of Tissue Engineering Research

基　　金：北京市卫生局科研基金资助项目(QML20160402);北京市科学技术委员会专项经费资助项目(Z161100000516134)

摘　　要：背景:人工间盘尺寸与椎体终板大小并不完全一致,而目前关于人工间盘大小对人工间盘置换效果的影响还未明确。目的:探讨Bryan间盘大小对颈椎人工间盘置换效果的影响。方法:纳入2003年12月至2007年12月因颈椎退行性疾病行单节段Bryan人工间盘置换的患者71例,平均年龄(45.90±8.12)岁,均随访10年以上。在X射线侧位片上测量人工间盘大小,人工间盘大小=(Bryan人工间盘端板矢状径×2y(置换节段上终板矢状径+置换节段下终板矢状径)×100%。分别于术前、术后3个月及末次随访时拍摄X射线片,测量置换节段活动度。并于术前、术后评估临床疗效,包括JOA评分、颈椎功能障碍指数和Odom’s评分。并对不同人工间盘大小(≥95%及<95%组)患者的观察指标进行统计对比分析。结果与结论:(1)人工间盘大小比例≥95%组49例,人工间盘大小比例<95%组22例;(2)术后3个月随访时,人工间盘大小<95%组置换节段活动度显著小于≥95%组(P<0.01);末次随访时,人工间盘大小<95%组置换节段活动度小于≥95%组(P<0.05);(3)末次随访时,人工间盘大小<95%组JOA评分改善率为(70.65±32.58)%;人工间盘大小≥95%组JOA评分改善率为(68.83±38.85)%,2组间差异无显著性意义(P>0.05);(4)末次随访时,人工间盘大小<95%组NDI减低(10.82±7.50)%;人工间盘大小≥95%组末次随访时NDI减低(12.61±8.51)%,2组间差异无显著性意义(P>0.05);(5)末次随访时,人工间盘大小<95%组Odem’s评分优10例(45%),良9例(41%),可3例(14%);人工间盘大小≥95%组Odem’s评分优26例(53%),良20例(41%),可3例(6%),2组间差异无显著性意义(P>0.05);(6)结果表明,2组不同大小的颈椎人工间盘置换后均获得了良好的功能恢复,但人工间盘过小会对置换节段活动度产生影响,应尽量避免置入的人工间盘与终板比例<95%。BACKGROUND:The size of artificial disc is not exactly identical to cervical vertebral endplate.However,the effect of implant size on cervical disc replacement has not yet been clearly identified.OBJECTIVE:To evaluate the effect of Bryan disc size on cervical artificial disc replacement.METHODS:Totally 71 patients with cervical degenerative disease underwent single-level Bryan disc replacement from December 2003 to December 2007 were enrolled.The average age was(45.90±8.12)years old,and all patients were followed up for more than 10 years.The artificial disc size was measured using lateral X-ray films,and expressed as(Bryan artificial disc’s footprint sagittal diameter×2)/(upper endplate sagittal diameter+lower endplate’s sagittal diameter)×100%.X-ray films were photographed to measure motion range of the treated segment before surgery,3 months after surgery,and during final follow-up.Clinical outcomes,including Japanese Orthopaedic Association score,Neck Disability Index and Odom’s scores,were evaluated before and after operation.Observational indexes of different disc sizes(≥95%and<95%groups)were compared and analyzed.RESULTS AND CONCLUSION:(1)There were 49 patients in the≥95%group and 22 patients in the<95%group.(2)At 3-month follow-up,range of motion was significantly smaller in the<95%group than in the≥95%group(P<0.01).At the final follow-up,range of motion was significantly smaller in the<95%group than in the≥95%group(P<0.05).(3)At final follow-up,improvement rate of Japanese Orthopaedic Association score was(70.65±32.58)%in the<95%group and(68.83±38.85)%in the≥95%group,and no significant difference was detected between the two groups(P>0.05).(4)At final follow-up,Neck Disability Index decreased by(10.82±7.50)%in the<95%group,and(12.61±8.51)%in the≥95%group,and no significant difference was detected between the two groups(P>0.05).(5)At final follow-up,Odem’s score results showed excellent in 10 cases(45%),good in 9 cases(41%)and average in 3 cases(14%)in the<95%group;and excellent

关 键 词：颈椎人工间盘置换 人工间盘大小 长期随访 骨科植入物 脊柱植入物 颈椎 随访研究 组织工程 

分 类 号：R318[医药卫生—生物医学工程]