颈椎下终板形态对人工颈椎间盘置换术后临床疗效的影响  

Efficacy of Inferior Endplate Morphology on Clinical Effect of Artificial Cervical Disc Replacement

作　　者：史晓萌 李春根 柳根哲[2] 尹辛成[2] 陈超 郑皓云 祝永刚[2] 赵思浩 SHI Xiaomemg;LI Chungen;LIU Genzhe;YIN Xincheng;CHEN Chao;ZHENG Haoyun;ZHU Yonggang;ZHAO Sihao(Beijing University of Chinese Medicine,Beijing 100029,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]北京中医药大学,北京100029 [2]首都医科大学附属北京中医医院骨科

出　　处：《中国中医骨伤科杂志》2022年第5期16-22,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:观察颈椎下终板形态对人工颈椎间盘置换术(Artificial Cervical Disc Replacement,ACDR)的影响。方法:回顾性分析2018年1月至2020年9月收治的行单节段ACDR的颈椎病患者44例。根据术前颈椎下终板穹隆顶点位置将患者分为3组:A组(Ⅰ型),穹隆顶点位置靠前;B组(Ⅱ型),穹隆顶点位置居中;C组(Ⅲ型),穹隆顶点位置靠后。比较患者的临床评分和影像学参数,并按Odom's标准评定治疗效果。结果:椎体下终板矢状径平均为(17.13±2.62)mm,下终板穹隆高度平均为(2.18±0.75)mm。终板形态分布:Ⅰ型8例(18%),Ⅱ型13例(30%),Ⅲ型23例(52%)。术后平均随访(21.73±8.62)个月,VAS、NDI评分较术前下降,差异有统计学意义(P<0.05);JOA评分较术前升高,改善率为73.13%,差异有统计学意义(P<0.05)。与术前相比,FSU、SVA、手术节段活动度及整体活动度,差异有统计学意义(P<0.05);C_(2)~C_(7)Cobb角、T_(1)倾斜角差异无统计学意义(P>0.05)。3组终板形态之间,C_(2)~C_(7)Cobb角在末次随访时差异有统计学意义(P<0.05)。邻近节段退变(ASD)2例(4.55%)。Odom's标准评定结果:优25例,良13例,可4例,差2例,优良率为86.36%。结论:ACDR术后短期随访临床疗效满意,颈椎下终板形态对术后颈椎整体曲度恢复产生一定影响。Objective:To observe the efficacy of inferior endplate morphology on artificial cervical disc replacement(ACDR).Methods:A retrospective analysis was performed on 44patients with ACDR with cervical spondylosis admitted to hospital from January 2018to September 2020.Patients were divided into three groups according to the position of the apex of the lower endplate dome:group A(typeⅠ),the dome apex was located in front;group B(typeⅡ),the dome apex was located in the middle;group C(typeⅢ),the dome apex was located at the back.The clinical scores and imaging parameters of patients with different endplate morphology before and after operation and in each group were compared,and the treatment efficacy was evaluated according to Odom's standard.Results:The sagittal diameter of the upper endplate was recorded as(17.13±2.62)mm,and the average dome height of the lower endplate was recorded as(2.18±0.75)mm.Endplate morphology distribution was recoded as 8cases in typeⅠ(18%),13cases in typeⅡ(30%),23cases in typeⅢ(52%).They were followed up by(21.73±8.62)months.Compared with the preoperative results,the VAS and NDI scores were shown statistically significant differences(P<0.05).The improvement rate of JOA score was recorded as 73.13%and the difference was shown statistically significant(P<0.05).Compared with before operation,FSU,SVA,range of activity of operation segment and total activity were shown significantly different(P<0.05).C_(2) to C_(7) Cobb angle and T_(1) inclination angle were shown no significant difference(P>0.05).The difference of C_(2) to C_(7) Cobb angle between the three groups at the last follow-up was shown statistically significant(P<0.05).Adjacent seg-ment degeneration(ASD)was occurred in 2cases(4.55%).Odom's standard evaluation results were recorded as excellent 25cases,good 13cases,fair 4cases,poor 2cases,excellent and good rate 86.36%.Conclusion:The clinical efficacy of patients after ACDR is satisfactory,the shape of endplate has influence on postoperative cervical curvature.

关 键 词：颈椎病 人工颈椎间盘置换术 终板形态 临床疗效 颈椎曲度 

分 类 号：R681.5[医药卫生—骨科学]