頸椎間盤置換治療脊髓型頸椎病的療效觀察_《中國修復重建外科雜志》

作者：

嚴冬雪 ¹ , 肖增明 ² , 沈翀 ¹ , 黃永吉 ¹

1 桂林醫學院附屬醫院脊柱骨病外科（廣西桂林，541001）;;
2 廣西醫科大學附屬第一醫院脊柱關節外科;

關鍵詞：

頸椎間盤置換脊髓型頸椎病頸椎間盤突出癥

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目的探討頸椎間盤置換治療脊髓型頸椎病的療效。方法2006年10月－2008年10月，采用椎間盤置換治療20例（26個節段）脊髓型頸椎病患者。男8例，女12例；年齡26～65歲，平均46歲。病程2～18個月，平均7個月。單節段置換14例，雙節段置換6例。術后以Odom等標準評價療效，以疼痛視覺模擬評分（VAS）評價頸、肩部及上肢疼痛情況。X線片測量假體椎間盤間隙角及頸椎過屈、過伸位活動度，觀察異位骨化、骨贅形成及假體松動等情況。結果術后切口均Ⅰ期愈合，無嚴重并發癥發生。20 例均獲隨訪，隨訪時間30 ～ 48個月，平均34個月。術后28個月按Odom等標準獲優17例、良3例，頸、肩部及上肢VAS評分均較術前顯著改善（P lt; 0.05）。術后30個月，20個置換節段未融合，假體活動度為（10.6 ± 4.5）°，與上位相鄰節段的（10.8 ± 3.7）°和下位相鄰節段的（7.5 ± 4.2）°比較差異均無統計學意義（P gt; 0.05）。術后10例13個節段發生異位骨化，1例假體后方移位；其他假體無移位、下沉、松動等并發癥發生。結論頸椎間盤置換治療脊髓型頸椎病能維持頸椎正常活動范圍和生理彎曲，但其功能和對鄰近節段的影響需進一步隨訪。

引用本文： 嚴冬雪,肖增明,沈翀,黃永吉. 頸椎間盤置換治療脊髓型頸椎病的療效觀察. 中國修復重建外科雜志, 2012, 26(9): 1058-1061. doi: 復制

1.	劉忠軍. 脊柱外科手術操作與技巧. 北京: 人民衛生出版社, 2009: 26.
2.	Odom GL, Finney W, Woodhall B. Cervical disc lesions. J Am Med Assoc, 1958, 166(1): 23-28.
3.	McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
4.	農魯明, 周棟, 徐南偉, 等. 人工頸椎間盤置換術治療頸椎病的中期療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 567-571.
5.	郭隆升, 馬曉春, 付鵬, 等. Bryan人工椎間盤置換術治療頸椎病的初步探討. 中國現代醫學, 2010, 48(8): 144-148.
6.	Goffin J, van Loon J, van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow-up results after cervical disc replacement surgery using the Bryan cervical disc prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
7.	Cheng L, Nie L, Zhang L, et al. Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomized study. Int Orthop, 2008, 33(5): 1037-1351.
8.	Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic, changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
9.	Wenger M, van Hoonacker P, Zachee B, et al. Bryan cervical disc prosthesis: preservation of function over time. J Clin Neurosci, 2009, 16(2): 220-225.
10.	劉文華, 朱兵, 劉曉偉, 等. 單節段Bryan人工頸椎間盤置換術后異位骨化的發生率和療效觀察. 中國修復重建外科雜志, 2012, 26(6): 699-702.
11.	Leung C, Casey AT, Goffin J, et al. Clinical significance of heteroptopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery, 2005, 57(4): 759-763.
12.	Mehran C, Suchomel P, Grochulla F, et al. Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976), 2006, 31(24): 2802-2806.
13.	Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty: a prospective, randomized, controlled, single site trial with48-month follow-up. J Spinal Disord Tech, 2010, 23 (6): 367-371.
14.	Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty , 2009, 24(2): 256-262.
15.	Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
16.	Wu SK, Kuo LC, Lan HC, et al. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur Spine J, 2007, 16(9): 1435-1444.
17.	Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am), 1999, 81(4): 519-528.
18.	DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech, 2003, 16(4): 314-323.
19.	Faizan A, Goel VK, Garfin SR, et al. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation. Eur Spine J, 2012, 21 Suppl 5: 653-662.
20.	Zechmeister I, Winkler R, Mad P. Artificial total disc replacement versus fusion for the cervical spine: a systematic review. Eur Spine J, 2011, 20(2): 177-184.
21.	謝華, 徐南偉, 農魯明, 等. Prodisc-C人工頸椎間盤置換術治療中老年頸椎病的療效. 江蘇醫學, 2011, 37(6): 691-693.

1. 劉忠軍. 脊柱外科手術操作與技巧. 北京: 人民衛生出版社, 2009: 26.
2. Odom GL, Finney W, Woodhall B. Cervical disc lesions. J Am Med Assoc, 1958, 166(1): 23-28.
3. McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
4. 農魯明, 周棟, 徐南偉, 等. 人工頸椎間盤置換術治療頸椎病的中期療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 567-571.
5. 郭隆升, 馬曉春, 付鵬, 等. Bryan人工椎間盤置換術治療頸椎病的初步探討. 中國現代醫學, 2010, 48(8): 144-148.
6. Goffin J, van Loon J, van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow-up results after cervical disc replacement surgery using the Bryan cervical disc prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
7. Cheng L, Nie L, Zhang L, et al. Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomized study. Int Orthop, 2008, 33(5): 1037-1351.
8. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic, changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
9. Wenger M, van Hoonacker P, Zachee B, et al. Bryan cervical disc prosthesis: preservation of function over time. J Clin Neurosci, 2009, 16(2): 220-225.
10. 劉文華, 朱兵, 劉曉偉, 等. 單節段Bryan人工頸椎間盤置換術后異位骨化的發生率和療效觀察. 中國修復重建外科雜志, 2012, 26(6): 699-702.
11. Leung C, Casey AT, Goffin J, et al. Clinical significance of heteroptopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery, 2005, 57(4): 759-763.
12. Mehran C, Suchomel P, Grochulla F, et al. Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976), 2006, 31(24): 2802-2806.
13. Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty: a prospective, randomized, controlled, single site trial with48-month follow-up. J Spinal Disord Tech, 2010, 23 (6): 367-371.
14. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty , 2009, 24(2): 256-262.
15. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
16. Wu SK, Kuo LC, Lan HC, et al. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur Spine J, 2007, 16(9): 1435-1444.
17. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am), 1999, 81(4): 519-528.
18. DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech, 2003, 16(4): 314-323.
19. Faizan A, Goel VK, Garfin SR, et al. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation. Eur Spine J, 2012, 21 Suppl 5: 653-662.
20. Zechmeister I, Winkler R, Mad P. Artificial total disc replacement versus fusion for the cervical spine: a systematic review. Eur Spine J, 2011, 20(2): 177-184.
21. 謝華, 徐南偉, 農魯明, 等. Prodisc-C人工頸椎間盤置換術治療中老年頸椎病的療效. 江蘇醫學, 2011, 37(6): 691-693.

《中國修復重建外科雜志》

頸椎間盤置換治療脊髓型頸椎病的療效觀察

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《中國修復重建外科雜志》

頸椎間盤置換治療脊髓型頸椎病的療效觀察

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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