人工颈椎间盘置换术后颈椎小关节退变的危险因素研究  

Risk factors of cervical facet joint degeneration after artificial cervical disc replacement

作　　者：张波[1] 王晋超[1] 姜宇桢 宋卿鹏 安岩[1] ZHANG Bo;WANG Jin-chao;JIANG Yuzhen;SONG Qing-peng;AN Yan(Department of Spine,Beijing Jishuian Haspial,Beijing 100355 China)

机构地区：[1]北京积水潭医院脊柱外科,100035

出　　处：《中国骨与关节杂志》2022年第8期606-610,共5页Chinese Journal of Bone and Joint

摘　　要：目的 探究人工颈椎间盘置换(artificial cervical disc replacement,ACDR)术后颈椎小关节退变的危险因素。方法 回顾性分析我院2016年6月至2018年6月行单节段Bryan ACDR的颈椎退行性疾病患者80例,术前、术后及末次随访时通过颈椎动力位X线片测量手术节段活动度和颈椎整体活动度,术前及末次随访同时进行日本骨科协会(Japanese Orthopaedic Association,JOA)评分及颈椎功能障碍指数量表(neck disabilitv index,NDI)评估患者临床症状,术前、末次随访时通过CT影像根据颈椎小关节定量评分系统评估颈椎小关节退变程度,在末次随访时进行Odom标准评价分级和颈痛的疼痛视觉模拟评分(visual analogue scale,VAS)。结果 小关节退变与男性(r=-0.263,P <0.05)、高龄(r=0.324,P <0.05)具有相关性,与手术节段没有相关性(P> 0.05)。患者术前手术节段活动度、整体活动度与随访时相比差异无统计学意义(P> 0.05),术前小关节退变评分、JOA评分与随访时相比显著降低,NDI评分显著升高,差异有统计学意义(P <0.05),ACDR术后小关节退变程度与手术节段活动度(r=-0.358,P <0.05)、整体活动度(r=-0.363,P <0.05)呈负相关,与JOA、NDI、Odom、VAS评分无显著性相关(P> 0.05)。结论 小关节的退变是颈椎退行性疾病的常见并发症,ACDR术后远期小关节存在轻度退变增加,小关节退变与年龄和性别相关,高龄和男性是其危险因素,小关节的退变程度与患者术后临床症状的缓解程度无关,与活动度存在负相关。Objective To study the risk factors of cervical facet joint degeneration after artificial cervical disc replacement (ACDR).Methods A series of 80 patients with cervical degenerative diseases underwent ACDR by single-segment Bryan cervical device from June 2016 to June 2018 in our hospital.X-ray photograph was used to measure the range of motion of the affected side and whole cervical vertebra before surgery,after surgery and at the final follow-up.Clinical symptoms were evaluated by Japanese Orthopaedic Association (JOA) scores and neck disability index (NDI) before surgery and at the final follow-up;CT imaging was used to determine the degeneration by the cervical facet joint quantitative scoring system;Odom’s criteria and visual analogue scale (VAS)were applied at the final follow-up.Results The facet joint degeneration was correlated with the male and elder age(r=-0.263,r=0.324;P < 0.05);the surgical segment was not correlated with facet joint degeneration (P > 0.05);the range of motion of the affected side and whole cervical vertebra before surgery and at the final follow-up was not significantly different (P > 0.05);The facet joint degeneration scores and JOA scores at the final follow-up were lower than that before surgery,while NDI scores were higher than before (P < 0.05).The facet joint degeneration was negatively correlated with range of motion of the affected side and whole cervical vertebra after ACDR(r=-0.358,r=-0.363;P < 0.05),while not correlated with JOA,NDI,Odom’s criteria and VAS (P > 0.05).Conclusions The cervical facet joint degeneration is a common complication of cervical degenerative diseases;mild facet joint degeneration may be increased in the long term after ACDR;the facet joint degeneration is related to patients’ age and gender (male and elder age are risk factors),negatively related to the range of motion,but not correlated to clinical symptom relief.

关 键 词：全椎间盘置换 椎间盘退行性变 危险因素 活动范围 关节 

分 类 号：R687.3[医药卫生—骨科学]