颈椎间盘突出行人工间盘置换术后远期发生椎旁骨化的影响因素分析  

Analysis of Influencing Factors of Long-term Paravertebral Ossification After Cervical Artificial Disc Replacement in the Treatment of Cervical Disc Herniation

作　　者：张波[1] 王晋超[1] 姜宇桢 宋卿鹏 安岩[1] Zhang Bo;Wang Jinchao;Jiang Yuzhen;Song Qingpeng;An Yan(Department of Spine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035

出　　处：《实用骨科杂志》2022年第4期289-294,共6页Journal of Practical Orthopaedics

摘　　要：目的明确单纯颈椎间盘突出患者行颈椎人工间盘置换术(cervical artificial disc replacement,CADR)后远期椎旁骨化(paravertebral ossification,PO)的发生率,并分析CADR术后远期发生中高等级PO的影响因素。方法回顾性分析北京积水潭医院脊柱外科2003年12月至2007年12月间行Bryan人工间盘置换治疗颈椎间盘突出且随访10年以上的28例患者的临床资料,男性16例,女性12例;年龄37~64岁,平均年龄(54.21±8.7)岁;其中C_(3~4)节段1例,C_(4~5)节段4例,C_(5~6)节段19例,C_(6~7)节段4例。按照末次随访时手术节段的PO等级,将患者分为低等级组和中高等级组。比较两组患者颈椎整体活动度(range of motion,ROM)、手术节段ROM、手术节段曲度、人工间盘角、假体覆盖比、颈椎残障功能指数(neck disability index,NDI)、日本骨科协会(Japanese orthopaedic association,JOA)评分、Odom’s评分间差异,并使用Logistic多因素回归分析探讨术后远期中高等级PO形成的危险因素。结果低等级组11例,中高等级组17例,中高等级PO的发生率为60.7%。低等级组患者年龄(53.55±8.54)岁,术前手术节段曲度(2.88±0.98)°,手术节段ROM为(10.10±4.60)°,术后3个月手术节段ROM为(12.84±3.52)°,末次随访时手术节段曲度(2.56±1.21)°,手术节段ROM为(12.55±3.51)°;中高等级组患者年龄(54.65±9.08)岁,术前手术节段曲度(2.14±1.27)°,手术节段ROM为(9.15±4.82)°,术后3个月手术节段ROM为(9.98±3.33)°,末次随访时手术节段曲度为(1.37±1.85)°,手术节段ROM为(9.48±4.47)°。低等级组术后3个月的手术节段ROM显著优于中高等级组(P<0.05)。低等级组JOA改善率(72.34±40.84)%,NDI下降(11.64±7.58)%;中高等级组JOA改善率为(82.75±20.52)%,NDI下降(15.29±9.16)%,两组患者临床疗效间差异无统计学意义。多因素Logistic回归分析结果表明,术后3个月手术节段ROM是术后远期中高等级PO的独立危险因素(OR=1.565,P=0.047,95%CI:1.006~2.434)。结�Objective To determine the incidence of long-term paravertebral ossification(PO)after cervical artificial disc replacement(CADR)in patients with simple cervical disc herniation, and to analyze the influencing factors of mid-to-high grade PO in the long-term after CADR.Methods A retrospective analysis of 28 patients who underwent Bryan artificial disc replacement for cervical disc herniation in our hospital from December 2003 to December 2007 was conducted.The patients were followed up for more than 10 years.The study included 16 males and 12 females patients with an average age of(54.21±8.7),ranged from 37 to 64 years.There were 1 case at C_(3-),4 at C_(4-5),19 at C_(5-6),and 4 at C_(6-7).According to the PO grade of the surgical segment at the last follow-up, the patients were divided into low-grade group and mid-to-high-grade group.The overall cervical spine range of motion(ROM),surgical segment ROM,surgical segment curvature, artificial disc angle, prosthesis coverage ratio, neck disability index(NDI),Japanese Orthopedic Association score(JOA),Odom’s criteria were compared between the two groups of patients.The multivariate logistic regression analysis was used to explore the risk factors for the formation of mid-to-high-grade PO in the long-term after CADR.Results There were 11 cases in the low-grade group, 17 cases in the mid-to-high-grade group.The occurrence of mid-to-high-grade PO was 60.7%.The age of the patients in the low-grade group was(53.55±8.54),the preoperative segmental curvature was(2.88±0.98)°,and the preoperative operative segmental ROM was(10.10±4.60)°.The segmental ROM at 3 months follow-up was(12.84±3.52)°,the surgical segmental curvature at the last follow-up was(2.56±1.21)°,segmental ROM was(12.55±3.51)°;The age of the mid-to-high-grade group was(54.65±9.08),and the preoperative segmental curvature was(2.14± 1.27)°,segment ROM was(9.15±4.82)°,surgical segment ROM was(9.98±3.33)° at 3 months postoperatively.At the last follow-up, the surgical segment curvature was(1.37

关 键 词：颈椎人工间盘置换术 颈椎间盘突出 椎旁骨化 

分 类 号：R681.53[医药卫生—骨科学]