连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期研究  

A long-term study of heterotopic ossification after consecutive double-segment Bryan artificial cervical disc replacement

作　　者：丛梦琳 马鹤成 侯勇[1] 司萌[1] 聂林[1] CONG Menglin;MA Hecheng;HOU Yong(Department of Orthopedics,Qilu Hospital of Shandong University,Ji'nan,250012,China)

机构地区：[1]山东大学齐鲁医院脊柱外科,济南市250012

出　　处：《中国脊柱脊髓杂志》2020年第12期1081-1087,共7页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:对连续双节段Bryan人工颈椎间盘置换术后异位骨化的长期观察研究。方法 :回顾性分析我科2004年1月~2011年12月行连续双节段人工颈椎间盘置换术的患者21例,其中男性15例,女性6例;年龄33~72岁,平均50.4±8.8岁。C3/4、C4/5间盘置换5例,C4/5、C5/6间盘置换14例,C5/6、C6/7间盘置换2例。随访时间96~156个月,平均随访116.5±19.6个月。记录患者术前、术后3个月及末次随访时改良日本骨科协会评分(modified Japanese Orthopaedic Association,mJOA)、视觉模拟评分法(visual analogue scale,VAS)评分,末次随访时在颈椎动力位X线片中测量人工颈椎间盘活动度,颈椎侧位X线片中测量颈椎曲度,采用McAfee分级法在颈椎侧位及动力位X线片上对人工颈椎间盘的异位骨化情况进行评估。结果:患者术前mJOA评分14.0±2.0分。术后3个月时mJOA评分15.2±1.8分,末次随访时mJOA评分16.8±1.2分,均较术前有统计学差异(P<0.05)。术前VAS评分5.1±1.7分。术后3个月时VAS评分1.9±1.4分,末次随访时VAS评分0.9±0.8分,均较术前有统计学差异(P<0.05)。术前颈椎曲度为平均16.7°±6.6°,末次随访时颈椎曲度为15.7°±7.3°,无统计学差异(P=0.25)。上位节段活动度为6.23°±10.13°,下位节段活动度为3.76°±4.81°,有统计学差异(P=0.025)。至末次随访时16例发生异位骨化,发生率为76.2%。根据McAfee分级,21例患者42个节段中,Ⅰ级5个节段,Ⅱ级5个节段,Ⅲ级14个节段,Ⅳ级7个节段,发生Ⅲ级以上HO的概率为50%,上位节段发生Ⅲ级和Ⅳ级HO的概率为38.0%,下位节段发生Ⅲ级和Ⅳ级HO的概率为61.9%。结论:长期随访发现行连续双节段Bryan人工颈椎间盘置换术后异位骨化发生率较高,且下位节段发生严重HO的概率明显增加。Objectives: To observe the long-term follow-up outcome of cases underwent continuous doublesegment Bryan artificial disc replacement over 8 years. Methods: A total of 21 patients who underwent continuous double segment artificial cervical disc replacement in our hospital from Jan 2004 to Dec 2011 were enrolled. Among them, 4 cases presented radiculopathy, 15 cases myelopathy, and 2 cases mixed type. There were 14 cases of C4/5 and C5/6 disc replacement, 2 cases of C5/6 and C6/7 disc replacement, and 5 cases of C3/4 and C4/5 disc replacement. The mean follow-up time was 116.5±19.6 months. mJOA and VAS scores were recorded at pre-operation, 3 months after surgery and final follow-up. The patients′ segmental range of motion(ROM) was measured on the cervical dynamic X-ray film. The cervical lordosis was measured by lateral cervical X-ray film at final follow-up. The ectopic ossification of the artificial disc was evaluated on the cervical lateral X-ray film using McAfee classification method. Results: The mJOA score of 21 patients was14.0±2.0 points at preoperation, 15.2±1.8 at 3 months after surgery, and 16.8 ±1.2 at final follow-up. There were statistical differences between the postoperative scores andpreoperation score(P<0.05). The preoperative VAS score was 5.1±1.7 points, and the VAS score 3 months after surgery was 1.9±1.4, the VAS score at final follow-up was 0.9±0.8. The differences between the postoperative scores and preoperation score were with statistical significance. The cervical curvature before surgery was 16.7°±6.6° on average. The average cervical lordosis was 15.7°±7.3° at final follow-up. There was no statistical difference between that of preoperation and final follow-up(P=0.25). At final follow-up, the upper segment ROM was 6.23°±10.13° and the lower segment ROM was 3.76°±4.81°, the difference was with statistical significance(P=0.025). 16 cases developed heterotopic ossification at final follow-up, with an incidence of 76.2%. According to McAfee classification, among the 4

关 键 词：Bryan人工间盘 颈椎病 异位骨化 长期观察 

分 类 号：R687.3[医药卫生—骨科学]