术前症状持续时间对神经根型颈椎病患者行人工颈椎间盘置换术后疗效的影响研究  

Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients

作　　者：李益[1] 何俊波 吴廷奎 丁琛[1] 王贝宇[1] 刘浩[1] LI Yi;HE Junbo;WU Tingkui;DING Chen;WANG Beiyu;LIU Hao(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2024年第2期176-182,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(82172522);四川省干部保健重点研发项目(川干研ZH2023-105)。

摘　　要：目的探究术前症状持续时间对神经根型颈椎病(cervical spondylotic radiculopathy,CSR)患者行人工颈椎间盘置换术(cervical disc arthroplasty,CDA)后疗效的影响。方法回顾性分析2008年1月—2020年3月行单节段CDA且符合选择标准的90例CSR患者临床资料,根据术前症状持续时间分为早期干预组(59例,术前症状持续时间<24个月)和晚期干预组(31例,术前症状持续时间≥24个月)。两组患者年龄、性别、身体质量指数、吸烟状况、手术节段及术前颈部功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、颈椎曲度(cervical lordosis,CL)、C2~C7活动度(range of motion,ROM)、置换节段角(disc angle,DA)、置换节段ROM(disc ROM,DROM)、置换节段间隙高度(disc intervertebral height,DIH)等基线资料比较差异均无统计学意义(P>0.05);术前早期干预组日本骨科协会(JOA)评分略高于晚期干预组(P<0.05)。记录并比较两组手术时间、术中出血量、术后住院时间等围术期指标;采用末次随访时JOA评分、NDI及VAS评分较术前的变化值评价临床疗效,采用术前、术后即刻及末次随访时的CL、C2~C7 ROM、DA、DROM、DIH进行影像学评估;末次随访时,评估假体相关并发症发生情况,包括异位骨化(heterotopic ossification,HO)、椎体前缘骨吸收(anterior bone loss,ABL)及假体下沉。结果术后两组患者均获随访,随访时间24~120个月,平均53.4个月。两组手术时间、术中出血量、随访时间比较差异均无统计学意义(P>0.05);晚期干预组术后住院时间长于早期干预组(P<0.05)。末次随访时,两组患者JOA评分、NDI及VAS评分的手术前后变化值比较差异均无统计学意义(P>0.05)。随访期间两组均未出现手术翻修者,末次随访时两组HO、ABL及假体下沉发生情况比较差异均无统计学意义(P>0.05)。影像学评估示,手术前后各时间点两组间CL、C2~C7 ROM、DA、DROM、DIH差异均无统计学意义(P>0.05)。组内比较示,早�Objective To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty(CDA)in cervical spondylotic radiculopathy(CSR)patients.Methods The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed.Based on preoperative symptom duration,patients were divided into an early intervention group(preoperative symptom duration<24 months)and a late intervention group(preoperative symptom duration≥24 months).There was no significant difference in baseline data between the two groups(P>0.05),including age,gender,body mass index,smoking status,surgical segment,preoperative neck disability index(NDI),visual analogue scale(VAS)score,cervical lordosis(CL),C2-C7 range of motion(ROM),disc angle(DA),disc ROM(DROM),and disc intervertebral height(DIH).The early intervention group had a slightly higher preoperative Japan Orthopedic Association(JOA)score than the late intervention group(P<0.05).Perioperative indicators such as operation time,intraoperative blood loss,and postoperative hospital stay were recorded.The changes of JOA score,NDI,and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy,and the imaging evaluation of CL,C2-C7 ROM,DA,DROM,and DIH was performed before operation,immediately after operation,and at last follow-up.The incidence of prosthesis-related complications,including heterotopic ossification(HO),anterior bone loss(ABL),and prosthesis subsidence,was also assessed at last follow-up.Results Patients in both groups were followed up 24-120 months,with an average of 53.4 months.There was no significant difference in operation time,intraoperative blood loss,or follow-up duration between the groups(P>0.05).However,the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group(P<0.05).At last follow-up,there was no significant difference in the changes o

关 键 词：术前症状持续时间 神经根型颈椎病 人工颈椎间盘置换术 颈椎曲度 

分 类 号：R687.3[医药卫生—骨科学]