单节段ACDR与ACDF治疗伴可复性反弓颈椎病的疗效比较  

Artificial Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion for the Treatment of Single-level Disc Degenerative Disease with Reversible Kyphosis

作　　者：吴廷奎 胡旭[1] 刘浩[1] 王贝宇[1] 丁琛[1] 孟阳[1] 陈华[1] 杨毅[1] 洪瑛 黄康康 何俊波 Wu Tingkui;Hu Xu;Liu Hao(Department of Orthopedics,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041 [2]四川大学华西护理学院,四川大学华西医院麻醉手术中心,四川成都610041

出　　处：《实用骨科杂志》2021年第1期1-5,共5页Journal of Practical Orthopaedics

基　　金：四川省科技厅重点研发项目(2019YFQ0002);四川省科技厅重点研发项目(2019YFS0135);四川大学华西护理学科发展专项基金项目(HXHL19016)。

摘　　要：目的比较人工颈椎间盘置换术(artificial cervical disc replacement,ACDR)与前路减压融合术(anterior cervical discectomy and fusion,ACDF)治疗伴术前反弓的单节段颈椎病的临床和影像学结果。方法回顾分析2014—2018年在四川大学华西医院接受单节段Prestige-LP ACDR和单节段Zero-P ACDF且伴术前可复性反弓的患者。ACDR组27例,男14例,女13例;年龄37~51岁,平均(42.3±6.9)岁。ACDF组29例,男12例,女17例;年龄38~53岁,平均(43.7±7.6)岁。采用日本骨科学会评分(Japanese orthopaedic association,JOA)、疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)评价临床疗效。影像学评价包括颈椎整体和手术节段活动度(range of motion,ROM)、C 2~7角、脊柱功能单位角(functional spine unit,FSU),邻近节段退变(adjacent segment degeneration,ASD),异位骨化(helerotopic ossification,HO)。结果ACDR组随访时间25~66个月,平均(40.6±10.4)个月。ACDF组随访时间21~63个月,平均(39.7±9.5)个月。两组临床症状均显著改善,组间比较差异无统计学意义。与同组术前相比,两组的C 2~7角和FSU显著增大,而术后两组的C 2~7 ROM与术前相比差异无统计学意义。末次随访时,两组间FSU、C 2~7 ROM和C 2~7角比较,差异无统计学意义。ACDR组手术节段ROM显著大于ACDF组,差异有统计学意义。ACDR组3例发生ASD,ACDF组5例发生ASD,组间比较差异无统计学意义。根据McAfee分级,ACDR组有59.3%(16/27)的患者发生HO,其中5例3级HO,2例4级HO。结论人工颈椎间盘置换术与前路减压融合术均在伴术前反弓的单节段颈椎病中取得了良好的临床效果。对于该类患者,ACDR在改善颈椎曲度方面不劣于ACDF,但是ACDR组患者有较高的HO发生率。Objective To compare the clinical and radiological outcomes of single-level artificial cervical disc replacement(ACDR)and single-level anterior cervical discectomy and fusion(ACDF)in patients with preoperative reversible kyphosis(RK).Methods Twenty-seven ACDR patients(male/female:14/13)with a mean age of(42.3±6.9)years(range,37~51 years)and 29 ACDF patients(male/female:12/17)with a mean age of(43.7±7.6)years(range,38~53 years)were included.The Japanese orthopedic association(JOA)score,neck disability index(NDI),and visual analogue scale(VAS)were used to evaluate clinical outcomes.Range of motion(ROM),the segmental angle at the index level,C 2~7 angle,functional spinal unit(FSU)angle,adjacent segment degeneration(ASD),and heterotopic ossification(HO)were assessed.Results The follow-up averaged(40.6±10.4)months(range,25~66 months)in ACDR and(39.7±9.5)months(range,21~63 months)in ACDF.Both groups had significant improvements in clinical outcomes without significant intergroup differences.Compared with preoperative values,C 2~7 angle and FSU increased significantly in both groups,while the C 2~7 ROM was preserved.At the last follow-up,the C 2~7 angle,FSU,and C 2~7 ROM remained comparable between groups.The ACDR group had a significantly higher segmental ROM at the surgical level than ACDFgroup.Three ASD cases were noticed in ACDR group,while 5 cases were observed in ACDF group.According to McAfee classification,59.3%(16/27)ACDR patients developed HO(5 cases of gradeⅢ;2 cases of gradeⅣ).Conclusion Both ACDR and ACDF have satisfactory clinical results for the treatment of single-level disc degenerative disease with preoperative RK.ACDR is non-inferior to ACDF regarding the radiological outcomes of cervical alignment.ACDR group had a relatively high incidence of HO formation.

关 键 词：人工颈椎间盘置换术 前路减压融合术 可复性反弓 颈椎病 

分 类 号：R681.55[医药卫生—骨科学]