颈椎人工椎间盘置换术治疗单节段颈椎病的长期疗效及安全性  

Long-term efficacy and safety of single-segment cervical total disc replacement for cervical spondylosis

作　　者：赵寅 唐一钒 孙延卿 周盛源 贾连顺 陈雄生 Zhao Yin;Tang Yifan;Sun Yanqing;Zhou Shengyuan;Jia lianshun;Chen Xiongsheng(Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学长征医院骨科,上海200003

出　　处：《脊柱外科杂志》2022年第3期159-164,共6页Journal of Spinal Surgery

基　　金：长征医院院级课题项目(2017CZQN04);长征医院人才建设三年行动计划--“金字塔人才工程”优秀青年医师项目。

摘　　要：目的评估颈椎人工椎间盘置换术(CTDR)治疗单节段颈椎病的长期疗效及安全性。方法回顾性分析2009年1月—2010年7月采用CTDR治疗并获10年以上随访的31例单节段颈椎病患者临床资料。采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分及颈椎功能障碍指数(NDI)评价患者神经功能。采用影像学资料评估C_(2-7) Cobb角、节段活动度(ROM)、椎间盘退行性变Pfirrmann分级及异位骨化(HO)McAfee等级。记录术后神经功能恶化、脑脊液漏、HO、人工假体相关并发症、邻椎病等并发症发生情况。结果所有患者随访120~138(128.26±5.82)个月。末次随访时,C_(2-7) Cobb角无明显变化;VAS评分、JOA评分及NDI均较术前明显改善,差异有统计学意义(P<0.05)。末次随访时,置换节段ROM较术前有所下降,差异有统计学意义(P<0.05);上、下邻近节段及非邻近节段ROM较术前无明显变化,差异无统计学意义(P>0.05);上、下邻近节段及非邻近节段Pfirrmann分级均较术前显著进展,差异有统计学意义(P<0.05)。末次随访时,发生HO 12例(38.71%),包括McAfeeⅠ级2例,Ⅱ级4例,Ⅲ级6例;随着时间延长,HO发生率趋于稳定,但McAfeeⅢ级比例仍持续升高。术后出现假体下沉前移2例(6.45%),置换节段ROM均轻度下降,无神经功能恶化或后凸畸形,未予外科处理。结论CTDR在改善神经功能、维持颈椎生理曲度和保留手术节段ROM方面具有良好的长期疗效;虽有HO、假体相关并发症及邻近节段退行性变发生,但并未导致邻椎病、神经功能恶化或后凸畸形,具有较高的安全性。Objective To evaluate the long-term efficacy and safety of single-segment cervical total disc replacement(CTDR)in the treatment of cervical spondylosis.Methods The clinical data of 31 patients treated with single segment CTDR from January 2009 to July 2010 and followed up for more than 10 years were analyzed retrospectively.The neurological function of the patients was evaluated by pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and neck disability index(NDI).C_(2-7) Cobb angle,segmental range of motion(ROM),Pfirrmann grading of intervertebral disc degeneration and McAfee grading of heterotopic ossification(HO)were evaluated by imaging data.The complications such as neurological deterioration,cerebrospinal fluid leakage,HO,prosthesis related complications and adjacent vertebral disease were recorded.Results All the patients were followed up for 120-138(128.26±5.82)months.At the final follow-up,there was no significant change in C_(2-7) Cobb angle,but VAS score,JOA score and NDI were significantly improved compared with those before operation all with a statistical significance(P<0.05).At the final follow-up,the ROM of the replacement segment decreased compared with that before operation,and the difference was statistically significant(P<0.05).The ROM of the upper and lower adjacent segments and non adjacent segments had no significant change compared with that before operation,and the difference was not statistically significant(P>0.05).However,the Pfirrmann grading of the upper and lower adjacent segments and non adjacent segments had significant progress compared with that before operation,and the difference was statistically significant(P<0.05).At the final follow-up,12 patients(38.71%)had HO,including 2 cases of McAfee gradingⅠ,4 of gradingⅡand 6 of gradingⅢ;and with the extension of time,the incidence of HO tended to be stable,but the proportion of McAfee gradingⅢcontinued to increase.There were 2 patients(6.45%)with prosthesis subsidence and forward movement after op

关 键 词：颈椎 颈椎病 假体和植入物 骨化 异位性 

分 类 号：R681.531[医药卫生—骨科学]