Pretic-Ⅰ人工颈椎间盘置换术治疗颈椎间盘突出症的早期疗效观察
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摘要
目的总结采用一种新型人工颈椎间盘(Pretic-Ⅰ)行人工颈椎间盘置换术的早期疗效。方法回顾分析2014年6月—12月采用Pretic-Ⅰ人工椎间盘置换术治疗的10例单间隙颈椎间盘突出症患者临床资料。其中男4例,女6例;年龄27~51岁,平均40岁。病程4~36个月,平均15.4个月。手术节段:C_(4、5)1例,C_(5、6) 8例,C_(6、7) 1例。术前、术后即刻及术后3、6、12个月采用疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)评价疗效;于颈椎X线片测量目标椎间隙高度,目标椎间隙及上、下位相邻椎间隙活动度,评价颈椎运动功能。结果患者均顺利完成手术并获随访12个月。随访期间未出现神经症状加重、椎动脉损伤、食管气管瘘、脑脊液漏、切口感染、血肿形成、假体松动、脱落等并发症。术后各时间点VAS评分、JOA评分及NDI均较术前显著改善(P<0.05)。术后即刻及3个月时目标椎间隙高度显著高于术前(P<0.05);术后6、12个月与术前比较差异无统计学意义(P>0.05)。术后各时间点目标椎间隙及上、下位相邻椎间隙活动度与术前比较差异均无统计学意义(P>0.05)。结论 Pretic-Ⅰ人工颈椎间盘置换术治疗单间隙颈椎间盘突出症早期疗效良好,临床症状改善明显,同时较好地维持了手术节段及上、下相邻间隙的运动特征。
Objective To observe the early effectiveness of cervical disc replacement with Pretic-Ⅰ, a new type artificial disc. Methods A retrospective analysis was made on the clinical data of 10 patients who underwent single segmental cervical disc replacement with Pretic-Ⅰ from June to December 2014. Among 10 patients, 4 were male and 6 were female, with an average age of 40 years(range, 27-51 years). The mean disease duration was 15.4 months(range,4-36 months). Affected segments located at C_(4, 5) level in 1 case, at C_(5, 6) level in 8 cases, and at C_(6, 7) level in 1 case. The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score, and neck disability index(NDI) were used to evaluate the clinical outcomes. Besides, the disc height and the range of motion(ROM) at operated level, and ROM of upper and lower adjacent level were measured to assess the function. Results The operation was successfully completed in all patients who were followed up for 12 months. No complications of aggravated nerve symptoms, vertebral artery injury, esophagotracheal fistula, cerebrospinal fluid leakage, incision infection, hematoma and prosthetic loosening were observed during follow-up. The VAS score, JOA score, and NDI significantly improved at each time point after operation when compared with preoperative scores(P<0.05). The height of intervertebral disc at operated level was significantly increased at immediate and 3 months after operation when compared with preoperative one(P<0.05), but no significant difference was found between at 6 months or 12 months after operation and at pre-operation(P>0.05). No significant difference was shown in the ROM at operated level, and ROM of upper and lower adjacent level between at pre-operation a nd at each time point after operation(P>0.05). Conclusion The early effctiveness of cervical disc replacement using Pretic-Ⅰ is satisfactory. The symptoms can be relieved significantly and the dynamic features of the operated level, as well as the upper and lower adjacent levels, are well preserved.
Objective To observe the early effectiveness of cervical disc replacement with Pretic-Ⅰ, a new type artificial disc. Methods A retrospective analysis was made on the clinical data of 10 patients who underwent single segmental cervical disc replacement with Pretic-Ⅰ from June to December 2014. Among 10 patients, 4 were male and 6 were female, with an average age of 40 years(range, 27-51 years). The mean disease duration was 15.4 months(range,4-36 months). Affected segments located at C_(4, 5) level in 1 case, at C_(5, 6) level in 8 cases, and at C_(6, 7) level in 1 case. The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score, and neck disability index(NDI) were used to evaluate the clinical outcomes. Besides, the disc height and the range of motion(ROM) at operated level, and ROM of upper and lower adjacent level were measured to assess the function. Results The operation was successfully completed in all patients who were followed up for 12 months. No complications of aggravated nerve symptoms, vertebral artery injury, esophagotracheal fistula, cerebrospinal fluid leakage, incision infection, hematoma and prosthetic loosening were observed during follow-up. The VAS score, JOA score, and NDI significantly improved at each time point after operation when compared with preoperative scores(P<0.05). The height of intervertebral disc at operated level was significantly increased at immediate and 3 months after operation when compared with preoperative one(P<0.05), but no significant difference was found between at 6 months or 12 months after operation and at pre-operation(P>0.05). No significant difference was shown in the ROM at operated level, and ROM of upper and lower adjacent level between at pre-operation a nd at each time point after operation(P>0.05). Conclusion The early effctiveness of cervical disc replacement using Pretic-Ⅰ is satisfactory. The symptoms can be relieved significantly and the dynamic features of the operated level, as well as the upper and lower adjacent levels, are well preserved.
引文
1 丁琛,刘浩,龚全,等.人工颈椎间盘置换与颈前路融合术治疗脊髓型颈椎病3年随访结果报道.中国矫形外科杂志,2014,22(3):208-214.
2 曹俊明,申勇,杨大龙,等.Bryan人工颈椎间盘置换与颈前路椎间融合术后轴性症状的对比分析.中国修复重建外科杂志,2008,22(10):1200-1204.
3 田永福,刘雅莉,杨克虎,等.颈椎间盘置换与颈前路减压植骨融合术治疗单节段颈椎病疗效的系统评价.中国组织工程研究与临床康复,2009,13(35):6831-6835.
4 Sasso RC,Best NM,Metcalf NH,et al.Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and fusion:results from a prospective,randomized,multicenter,clinical trial.JSpinal Disord Tech,2008,21(6):393-399.
5 Park DK,Lin EL,Phillips FM.Index and adjacent level kinematics after cervical disc replacement and anterior fusion:in vivo quantitative radiographic analysis.Spine(Phila Pa 1976),2011,36(9):721-730.
6 Mc Afee PC.The advantages of cervical disc replacement for the treatment of degenerative disc disease.Curr Opin Orthop,2006,17(3):233-239.
7 蒋涛,任先军,王卫东,等.人工颈椎间盘置换对邻近节段椎间盘的保护作用.中国矫形外科杂志,2010,18(7):529-533.
8 Bhatnagar R,Bergin P,Yu W,et al.Cervical disc arthroplasty.Curr Orthop Pract,2010,21(3):306-309.
9 Kelly MP,Mok JM,Frisch RF,et al.Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty:analysis from a randomized,controlled trial.Spine(Phila Pa 1976),2011,36(15):1171-1179.
10 Thaler M,Hartmann S,Gst?ttner M,et al.Footprint mismatch in total cervical disc arthroplasty.Eur Spine J,2013,22(4):759-765.
11 Dong L,Tan MS,Yan QH,et al.Footprint mismatch of cervical disc prostheses with Chinese cervical anatomic dimensions.Chin Med J(Engl),2015,128(2):197-202.
12 罗成,瞿霞,陈波,等.颈椎间盘置换和椎间盘切除植骨融合修复单节段颈椎病:随机对照中期随访.中国组织工程研究,2015,19(9):1358-1364.
13 刘文华,朱兵,刘晓伟,等.单节段Bryan人工颈椎间盘置换术后异位骨化的发生率和疗效观察.中国修复重建外科杂志,2012,26(6):699-702.
14 邓宇骁,洪瑛,刘浩,等.椎间盘置换中体位对假体置入后活动度的影响.中国组织工程研究,2012,16(39):7221-7226.
15 娄纪刚,刘浩,龚全,等.单节段Prestige LP人工颈椎间盘置换术后置换节段活动度的影响因素分析.颈腰痛杂志,2015,36(1):20-24.
16 丁琛,刘浩,胡韬,等.Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访.中国组织工程研究与临床康复,2011,15(17):3047-3052.
17 Sasso RC,Best NM.Cervical kinematics after fusion and bryan disc arthroplasty.J Spinal Disord Tech,2008,21(1):19-22.
18 Park JJ,Quirno M,Cunningham MR,et al.Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.Spine(Phila Pa 1976),2010,35(8):E285-289.
19 Snyder JT,Tzermiadianos MN,Ghanayem AJ,et al.Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement.Spine(Phila Pa 1976),2007,32(26):2965-2969.
20 Sasso RC,Smucker JD,Hacker RJ,et al.Artificial disc versus fusion:a prospective,randomized study with 2-year follow-up on 99 patients.Spine(Phila Pa 1976),2007,32(26):2933-2940.
21 Rabin D,Pickett GE,Bisnaire L,et al.The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc:a pilot study.Neurosurgery,2007,61(3 Suppl):100-105.
22 Liu F,Cheng J,Komistek RD,et al.In vivo evaluation of dynamic characteristics of the normal,fused,and disc replacement cervical spines.Spine(Phila Pa 1976),2007,32(23):2578-2584.
23 Galbusera F,Bellini CM,Brayda-Bruno M,et al.Biomechanical studies on cervical total disc arthroplasty:a literature review.Clin Biomech(Bristol,Avon),2008,23(9):1095-1104.
24 洪瑛,邓宇骁,刘浩,等.单节段颈椎间盘置换术中颈椎体位对术后颈椎中立位生理轴线重建的影响.中国修复重建外科杂志,2013,27(1):62-65.
25 Hrabálek L,Vaverka M,Houdek M.Cervical disc arthroplasty(Prodisc-C):analysis of 3 to 4-year follow up results.Rozhl Chir,2009,88(11):634-641.
26 Miyazaki M,Hymanson HJ,Morishita Y,et al.Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine.Spine(Phila Pa 1976),2008,33(23):E870-876.
27 Johnson JP,Lauryssen C,Cambron HO,et al.Sagittal alignment and the Bryan cervical artificial disc.Neurosurg Focus,2004,17(6):E14.
2 曹俊明,申勇,杨大龙,等.Bryan人工颈椎间盘置换与颈前路椎间融合术后轴性症状的对比分析.中国修复重建外科杂志,2008,22(10):1200-1204.
3 田永福,刘雅莉,杨克虎,等.颈椎间盘置换与颈前路减压植骨融合术治疗单节段颈椎病疗效的系统评价.中国组织工程研究与临床康复,2009,13(35):6831-6835.
4 Sasso RC,Best NM,Metcalf NH,et al.Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and fusion:results from a prospective,randomized,multicenter,clinical trial.JSpinal Disord Tech,2008,21(6):393-399.
5 Park DK,Lin EL,Phillips FM.Index and adjacent level kinematics after cervical disc replacement and anterior fusion:in vivo quantitative radiographic analysis.Spine(Phila Pa 1976),2011,36(9):721-730.
6 Mc Afee PC.The advantages of cervical disc replacement for the treatment of degenerative disc disease.Curr Opin Orthop,2006,17(3):233-239.
7 蒋涛,任先军,王卫东,等.人工颈椎间盘置换对邻近节段椎间盘的保护作用.中国矫形外科杂志,2010,18(7):529-533.
8 Bhatnagar R,Bergin P,Yu W,et al.Cervical disc arthroplasty.Curr Orthop Pract,2010,21(3):306-309.
9 Kelly MP,Mok JM,Frisch RF,et al.Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty:analysis from a randomized,controlled trial.Spine(Phila Pa 1976),2011,36(15):1171-1179.
10 Thaler M,Hartmann S,Gst?ttner M,et al.Footprint mismatch in total cervical disc arthroplasty.Eur Spine J,2013,22(4):759-765.
11 Dong L,Tan MS,Yan QH,et al.Footprint mismatch of cervical disc prostheses with Chinese cervical anatomic dimensions.Chin Med J(Engl),2015,128(2):197-202.
12 罗成,瞿霞,陈波,等.颈椎间盘置换和椎间盘切除植骨融合修复单节段颈椎病:随机对照中期随访.中国组织工程研究,2015,19(9):1358-1364.
13 刘文华,朱兵,刘晓伟,等.单节段Bryan人工颈椎间盘置换术后异位骨化的发生率和疗效观察.中国修复重建外科杂志,2012,26(6):699-702.
14 邓宇骁,洪瑛,刘浩,等.椎间盘置换中体位对假体置入后活动度的影响.中国组织工程研究,2012,16(39):7221-7226.
15 娄纪刚,刘浩,龚全,等.单节段Prestige LP人工颈椎间盘置换术后置换节段活动度的影响因素分析.颈腰痛杂志,2015,36(1):20-24.
16 丁琛,刘浩,胡韬,等.Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访.中国组织工程研究与临床康复,2011,15(17):3047-3052.
17 Sasso RC,Best NM.Cervical kinematics after fusion and bryan disc arthroplasty.J Spinal Disord Tech,2008,21(1):19-22.
18 Park JJ,Quirno M,Cunningham MR,et al.Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.Spine(Phila Pa 1976),2010,35(8):E285-289.
19 Snyder JT,Tzermiadianos MN,Ghanayem AJ,et al.Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement.Spine(Phila Pa 1976),2007,32(26):2965-2969.
20 Sasso RC,Smucker JD,Hacker RJ,et al.Artificial disc versus fusion:a prospective,randomized study with 2-year follow-up on 99 patients.Spine(Phila Pa 1976),2007,32(26):2933-2940.
21 Rabin D,Pickett GE,Bisnaire L,et al.The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc:a pilot study.Neurosurgery,2007,61(3 Suppl):100-105.
22 Liu F,Cheng J,Komistek RD,et al.In vivo evaluation of dynamic characteristics of the normal,fused,and disc replacement cervical spines.Spine(Phila Pa 1976),2007,32(23):2578-2584.
23 Galbusera F,Bellini CM,Brayda-Bruno M,et al.Biomechanical studies on cervical total disc arthroplasty:a literature review.Clin Biomech(Bristol,Avon),2008,23(9):1095-1104.
24 洪瑛,邓宇骁,刘浩,等.单节段颈椎间盘置换术中颈椎体位对术后颈椎中立位生理轴线重建的影响.中国修复重建外科杂志,2013,27(1):62-65.
25 Hrabálek L,Vaverka M,Houdek M.Cervical disc arthroplasty(Prodisc-C):analysis of 3 to 4-year follow up results.Rozhl Chir,2009,88(11):634-641.
26 Miyazaki M,Hymanson HJ,Morishita Y,et al.Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine.Spine(Phila Pa 1976),2008,33(23):E870-876.
27 Johnson JP,Lauryssen C,Cambron HO,et al.Sagittal alignment and the Bryan cervical artificial disc.Neurosurg Focus,2004,17(6):E14.
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