Prestige LP颈椎人工椎间盘置换术治疗单节段退行性颈椎病的远期疗效  

Long-term outcomes of Prestige LP cervical total disc replacement in treatment of single segment degenerative cervical spondylosis

作　　者：祝静雨 倪斌 杨军 许天明 陈飞 Zhu Jingyu;Ni Bin;Yang Jun;Xu Tianming;Chen Fei(Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China;Department of Orthopaedics,Navy No.905 Hospital of Chinese PLA,Shanghai 200050,China)

机构地区：[1]海军军医大学长征医院骨科,上海200003 [2]中国人民解放军海军第九○五医院骨科,上海200050

出　　处：《脊柱外科杂志》2022年第3期176-181,共6页Journal of Spinal Surgery

摘　　要：目的探讨Prestige LP颈椎人工椎间盘置换术(CTDR)治疗单节段退行性颈椎病的远期疗效。方法2009年1月—2010年12月,海军军医大学长征医院采用Prestige LP CTDR治疗单节段退行性颈椎病患者31例,其中脊髓型颈椎病(CSM)13例,神经根型颈椎病(CSR)15例,混合型颈椎病3例。采用颈椎功能障碍指数(NDI)、日本骨科学会(JOA)评分和疼痛视觉模拟量表(VAS)评分评估临床疗效。在X线片上测量颈椎曲度(C_(2-7) Cobb角)、手术节段及邻近节段活动度(ROM);采用X线片及CT观察是否发生异位骨化(HO);采用MRI观察邻近节段退行性变(ASD)程度。结果所有患者随访10.2~11.0年。术后各随访时间点患者NDI、JOA评分、颈部和上肢痛VAS评分较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时颈椎曲度、上下邻近节段ROM与术前相比,差异无统计学意义(P>0.05)。末次随访时手术节段ROM与术前、术后3个月和术后2年相比,差异有统计学意义(P<0.05)。末次随访时有13例(41.9%)患者发生不同程度HO,10例(32.3%)发生ASD,但并未发生颈痛、根性疼痛等不适症状。末次随访时发生HO患者的手术节段ROM比未发生HO的患者下降,差异有统计学意义(P<0.05)。结论采用Prestige LP CTDR治疗单节段退行性颈椎病具有良好的远期临床疗效,假体能在保持颈椎ROM的基础上减少手术相邻节段椎间盘的过度活动,但易发生HO而导致手术节段ROM下降。Objective To evaluate the long-term outcomes of cervical total disc replacement(CTDR)with Prestige LP prostheses in the treatment of single segment degenerative cervical spondylosis.Methods From January 2009 to December 2010,31 patients with single segment degenerative cervical spondylosis were treated by CTDR with Prestige LP prostheses in Changzheng Hospital,including 13 cases of cervical spondylotic myelopathy(CSM),15 of cervical spondylotic radiculopathy(CSR)and 3 of mixed cervical spondylosis.The neck disability index(NDI),the Japan Orthopedic Association(JOA)score and the pain visual analogue scale(VAS)score were used to evaluate the clinical outcomes.The roentgenographs were utilized to assess the cervical overall curvature(C_(2-7) Cobb angle)and the range of motion(ROM)of the operation and its adjacent segments.The heterotopic ossification(HO)was evaluated on the roentgenograph and CT,and the adjacent segment degeneration(ASD)was evaluated on MRI.Results All the patients were followed up for 10.2-11.0 years.At the final follow-up,the NDI,JOA scores and VAS scores of all the patients were significantly improved,and the differences were statistically significant compared with those before operation(P<0.05).There was no significant difference in the overall cervical curvature at the final follow-up compared with pre-operation(P>0.05).At the final follow-up,the ROM of operation segment decreased compared with that before operation,3 months and 2 years after operation,all with a statistical significance(P<0.05).At the final follow-up,13 patients(41.9%)had HO in various degrees,and 10(32.3%)had ASD,but no significant symptoms such as neck pain and root pain occurred.At the final follow-up,the ROM of operation segment was significantly lower in the HO patients compared with the patients without HO,and the difference was statistically significant(P<0.05).Conclusions CTDR with prestige LP prosthesis has a good long-term clinical effect in the treatment of single segment degenerative cervical spondylosis.The prosth

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]