颈椎单节段人工间盘置换治疗相关因素的分析及预测  

Analysis and prediction of related factors of single-level cervical total disc replacement

作　　者：和利 徐帅[2] 徐嵩 赵晓宇 庞士龙 苗军[3] 刘海鹰[2] 梁彦 He Li;Xu Shuai;Xu Song;Zhao Xiaoyu;Pang Shilong;Miao Jun;Liu Haiying;Liang Yan(Tianjin Ninghe Hospital,Tianjin 301500,China;Department of Spine Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Spine Surgery,Tianjin Hospital,Tianjin 300210,China)

机构地区：[1]天津宁河医院,天津市301500 [2]北京大学人民医院脊柱外科,北京市100044 [3]天津医院脊柱外科,天津市300210

出　　处：《中国组织工程研究》2020年第30期4782-4788,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81472140),项目负责人:苗军;北京大学人民医院研究与发展基金(RDD2016-02),项目负责人:刘海鹰。

摘　　要：背景:颈椎前方空间狭小,颈椎人工椎间盘置换术中止血不彻底或引流不畅,会引发一系列并发症。术前常见因素会直接影响脊柱修复术中出血量,目前尚无研究针对颈椎人工椎间盘置换的患者。目的:分析颈椎单节段人工间盘置换手术时间及出血量的相关影响因素。方法:回顾性分析2012年10月至2017年12月北京大学人民医院脊柱外科收治的行颈椎单节段人工间盘置换的颈椎病患者56例,测量其术前和术中相关参数。主要结果包括手术时间、出血量及术后引流量,次要结果包括人口统计学资料(性别、年龄、高血压等)、手术相关信息(手术节段、颈椎病类型、人工椎间盘类型等)、X射线影像学参数(C2-C7及手术节段活动度、前凸角、椎间隙高度等)、MRI分级(Modic分型、Pfirrmann分级等)和术前功能评分,分析主要结果与次要结果以及主要结果之间的相关性。结果与结论:①56例患者(男30例,女26例)平均年龄为(48.2±9.8)岁,手术时间为(73.2±13.4)min,术中出血及术后引流分别为(51.8±41.2)mL和(7.8±5.3)mL;②手术时间和术中出血在人口学方面差异均无显著性意义,术后伤口引流在年龄分布上差异存在显著性意义(P=0.030);③置入人工间盘Prestige-LP的手术时间短于Mobi-C和Prodisc-C(P<0.05);术前停服非类固醇抗炎药时间与术中出血量成正相关(r=0.310,P=0.020);手术节段椎间隙越高,手术时间相对越长(P=0.028);④骨质疏松患者相对于正常患者,术中出血更多(P=0.039),其余影像学参数与主要结果均无明确相关性;MRI评分、Modic分型和Pfirrmann分级等参数与主要结果无相关性;⑤手术时间与术中出血(P=0.010)及术后引流量(P=0.001)存在正相关性;⑥说明椎间隙高度增加会延长手术操作时间;骨质疏松为术中出血的危险因素;手术时间越长,术中出血及术后引流会相应增多。BACKGROUND:There is limited anterior cervical spine space.Incomplete hemostasis or drainage during artificial cervical total disc replacement can incur a series of complications.Preoperative factors can directly affect the amount of bleeding during spine surgery,while there are no publications aiming at cervical artificial disc replacement.OBJECTIVE:To analyze influencing factors on operation time and hemorrhage in patients undergoing single cervical total disc replacement.METHODS:Fifty-six patients with cervical spondylosis who underwent cervical total disc replacement from October 2012 to December 2017 in Department of Spine Surgery,Peking University People’s Hospital,were retrospectively enrolled.Pre-and intra-operative related parameters were measured.Primary outcomes included operation time,intraoperative blood loss and postoperative drainage.The secondary outcomes included demographic data such as sex,male and hypertension;surgery-related information such as operated segment,types of cervical spondylosis and artificial prosthesis;parameters in X-ray plain films such as the motion range and cervical lordosis of C2-C7 and index segment,the height of intervertebral disc,MRI classification(Modic classification and Pfirrmann classification)and preoperative functional score.The analysis was performed between primary and secondary outcomes as well as among primary outcomes.RESULTS AND CONCLUSION:(1)The average age of 56 patients(30 males and 26 females)was 48.2±9.8 years;operation time,intraoperative bleeding and postoperative drainage were 73.2±13.4 minutes,51.8±41.2 mL and 7.8±5.3 mL,respectively.(2)There were no differences both in operation time and intraoperative blood loss in terms of demographics,while the drainage was statistically different in various ages(P=0.030).(3)The operation time of Prestige-LP implantation was statistically shorter than that of Mobi-C and Prodisc-C(P<0.05).There was a positive correlation between the intermittent on taking(nonsteroidal antiinflammatory drugs)and intraoperati

关 键 词：骨 假体 影像 颈椎 颈椎病 椎间盘 间盘置换 骨质疏松 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]