单节段Bryan颈椎间盘置换远期屈伸旋转中心变化  

Long-term variation of flexion-extension center of rotation secondary to single-segment Bryan cervical disc replacement

作　　者：李传鸿 俞兴[1] 熊洋 杨永栋[1] 王逢贤[1] 赵赫[1] LI Chuan-hong;YU Xing;XIONG Yang;YANG Yong-dong;WANG Feng-xian;ZHAO He(Department of Orthopedics,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;School of Materials,Tsinghua University,Beijing 100084,China)

机构地区：[1]北京中医药大学东直门医院骨科,北京100700 [2]清华大学材料学院,北京100084

出　　处：《中国矫形外科杂志》2022年第11期967-972,共6页Orthopedic Journal of China

基　　金：潍坊奥精仿生骨多中心临床研究项目(编号:601111)。

摘　　要：[目的]观察单节段Bryan人工颈椎间盘置换术(artificial cervical disc replacement, ACDR)远期随访的运动学结果。[方法]回顾性分析2010年1月—2013年3月于本院行单节段Bryan ACDR且末次随访手术节段活动度(range of motion,ROM)>5°的38例患者的临床资料。观察临床与影像结果。[结果] 38例患者均顺利完成手术,无严重并发症。随访84~118个月,平均(93.97±9.67)个月。末次随访时,患者颈椎病相关症状明显改善,JOA评分较术前明显升高(P<0.05),NDI评分、颈痛及上肢痛VAS评分较术前显著降低(P<0.05)。至末次随访期时,所有患者均未出现症状加剧,无再次入院,无翻修手术。影像方面,与术前相比,末次随访时颈椎整体曲度和手术节段曲度均显著增加(P<0.05),而颈椎整体ROM、手术节段ROM、上邻节段ROM和下邻节段ROM,以及COR-X和COR-Y均无显著改变(P>0.05)。相关分析表明,末次随访时COR-Y与手术节段ROM呈显著负相关(P<0.05),与手术节段平移距离呈显著负相关(P<0.05);此外,手术节段ROM与同节段平移距离呈正相关(r=0.772,P<0.05)。COR-Y与其他临床和影像指标均无明显相关性(P>0.05),而COR-X与任何指标均无相关性(P>0.05)。[结论]单节段Bryan ACDR 7年以上随访临床疗效与影像结果满意。末次随访时手术节段COR-Y与平移、ROM的关系与正常颈椎节段类似,这有助于模拟颈椎生理运动模式。[Objective] To observe the long-term kinematic consequences, especially variation of the center of rotation(COR) of the involved segment, of single-segment Bryan cervical disc replacement(CDR). [Methods] A retrospective study was conducted on 38 patients who received single-segment Bryan CDR in our hospital from January 2010 to March 2013, and had range of motion(ROM) at the affected segment > 5° at the latest follow-up. Clinical and radiographic documents were analyzed. [Results] All the 38 patients had operation performed successfully without serious complications. The follow-up period lasted for 84 to 118 months, with a mean of(93.97±9.67) months.The symptoms related to cervical spondylosis were significantly improved at the latest follow-up. The JOA score significantly increased(P<0.05), whereas the NDI score and VAS scores for neck pain and upper limb pain significantly decreased postoperatively compared with those preoperatively(P<0.05). By the time of latest follow-up, no exacerbation of symptoms, readmission, or revision surgery had occurred in anyone of the patients. Radiographically, overall cervical curvature and involved segmental curvature significantly increased(P<0.05),whereas the overall ROM, involved segmental ROM, upper adjacent ROM and lower adjacent ROM, COR-X and COR-Y remained unchanged at the latest follow-up compared with those before operation(P>0.05). As correlation analysis, the COR-Y was significantly negatively correlated with the ROM(P<0.05), and the translational distance of the involved segment at the latest follow-up(P<0.05). In addition, the ROM was significantly positively correlated with translational distance of the same segment(r=0.772, P<0.05). The COR-Y had no significant correlation with other clinical and imaging items(P>0.05), while COR-X had no correlation with any parameters(P>0.05).[Conclusion] The clinical and radiographic results of single-segment Bryan CDR do still be satisfactory more than 7 years after operation.The relationships between COR-Y, translational di

关 键 词：人工颈椎间盘置换术 Bryan颈椎间盘 旋转中心 运动学 临床疗效 

分 类 号：R687[医药卫生—骨科学]