人工颈椎间盘置换术后椎体前缘骨吸收的危险因素分析及其与疗效相关性研究  

Analysis of risk factors of anterior vertebral bone resorption of centrum after artificial cervical disc replacement and its correlation with curative effect

作　　者：刘忠瀚 赵思浩 柳根哲[2] 尹辛成[2] 陈超 郑皓云 祝永刚[2] 李春根 LIU Zhonghan;ZHAO Sihao;LIU Genzhe;YIN Xincheng;CHEN Chao;ZHENG Haoyun;ZHU Yonggang;LI Chungen(Graduate School of Beijing University of Chinese Medicine,Beijing 100029;Orthopedics Department of Beijing Hospital of Traditional Chinese Medicine,Affiliated to Capital Medical University,Beijing 100010)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]首都医科大学附属北京中医医院骨科,北京100010

出　　处：《颈腰痛杂志》2025年第1期32-38,共7页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨Mobi-C人工颈椎间盘置换术(ACDR)术后椎体前缘骨吸收(AVBR)的发生情况、危险因素及其与症状相关性。方法回顾性分析2018年1月至2022年7月在本院行ACDR的颈椎病35例患者的临床资料及随访结果。术后平均随访(28.08±13.65)个月,观察其田中靖久颈椎病症状量表评分(YT20)、日本骨科协会(JOA)评估治疗分数、颈椎功能障碍指数量表(NDI)变化。在X线片上测量手术节段下位椎体终板前后径判定是否发生AVBR并对其进行分级,然后根据患者有无AVBR将其分为AVBR组(19例)与无AVBR组(16例),观察其AVBR的发生是否与症状相关。采用单因素分析探讨性别、年龄、体质量指数(BMI)、手术节段、骨密度、术前血钙浓度、术中出血量、手术时间、吸烟史、糖尿病、上位椎体下终板形态对AVBR的影响,然后采用二元Logistic回归分析进行分层分析。结果末次随访时,35例患者末次随访时YT20评分、JOA评分较术前明显升高,NDI评分较术前明显下降(P<0.05),C_(2-7)颈椎活动度(ROM)、置换阶段ROM较术前明显升高(P<0.05),末次随访C_(2-7)Cobb较术前无明显变化(P>0.05)。有19例出现了AVBR,发生率为54.2%,其中1级8例(42.11%),2级6例(31.58%),3级5例(26.31%),最早出现在术后3个月。两组患者的临床疗效与矢状位参数对比显示YT20评分、JOA评分及NDI评分差异无统计学意义。影像矢状位参数方面,两组患者的C_(2-7)ROM、C_(2-7)Cobb差异无统计学意义(P>0.05)。置换阶段ROM差异有统计学意义(P<0.05)。单因素方差分析(ANOVA)显示:两组的BMI、上位椎体下终板形态比较,差异有统计学意义(P<0.05),在性别、年龄、手术节段、骨密度、术前血钙浓度、术中出血量、手术时间、吸烟史、糖尿病病史比较,差异无统计学意义(P>0.05)。二分类Logistic回归分析显示,BMI(OR=0.631)和上位椎体下终板形态(OR=1.306)与AVBR的发生存在统计学关联。两组均无需再次手术Objective Exploring the occurrence of anterior vertebral bone resorption(AVBR),risk factors and correlation with symptoms after Mobi-C artificial cervical disc replacement(ACDR).Methods The clinical data and follow-up results of 35 patients with cervical spondylosis who received ACDR in our hospital from January 2018 to July 2022 were retrospectively analyzed.The mean follow-up was(28.08±13.65)months,and the changes of Tanaka Yasushi cervical spondylitis symptom scale 20(YT20)score,Japanese orthopaedic association(JOA)score and neck disability index(NDI)score were observed.The anterior-to-posterior diameter of the vertebral endplate below the operative level was measured on the radiographs to determine whether AVBR occurred and to grade them.Then,according to the presence or absence of AVBR,patients were divided into AVBR group(19 cases)and group without AVBR(16 cases),and whether the occurrence of AVBR was related to symptoms was observed.Univariate analysis was used to investigate the effects of gender,age,body mass index(BMI),surgical stage,bone mineral density,preoperative blood calcium concentration,intraoperative blood loss,surgical time,smoking history,diabetes mellitus,and inferior endplate shape of upper vertebrae on AVBR,and then stratified analysis was conducted by binary Logistics regression analysis.Results At the last follow-up,YT20 score and JOA score of 35 patients were significantly higher than before surgery,NDI score was significantly lower than before surgery(P<0.05),C_(2-7) range of motion(ROM)and replacement stage ROM were significantly higher than before surgery(P<0.05).At the last follow-up,there was no significant change in C_(2-7) Cobb compared with that before surgery(P>0.05).AVBR was present in 19 cases(54.2%),including 8 cases(42.11%)in grade 1,6 cases(31.58%)in grade 2,and 5 cases(26.31%)in grade 3.The earliest occurrence was 3 months after surgery.The comparison of clinical efficacy and sagittal position parameters between the two groups showed no statistical significance in YT20 s

关 键 词：颈椎病 人工颈椎间盘置换术 椎体前缘骨吸收 上位椎体下终板形态 危险因素 

分 类 号：R681.553.1[医药卫生—骨科学]