单双节段颈椎人工间盘置换术长期疗效比较
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摘要
目的探讨单节段与双节段颈椎人工间盘置换术对治疗颈椎退行性疾病长期临床疗效的影响。方法回顾性分析我院2003年12月至2007年12月间86例患者101个节段行单双节段Bryan人工间盘置换术且随访10年以上患者的临床资料,其中男51例,女35例;平均年龄(53.9±9.3)岁。按手术节段数患者分为两组:单节段组71个节段,双节段组30个节段。评估患者的临床功能指标,包括日本骨科学会(Japanese orthopaedic association,JOA)评分、颈椎功能障碍(neck disability index,NDI)及Odom's标准;影像学指标:包括颈椎整体活动度(range of motion,ROM)、手术节段ROM、手术节段Cobb角。比较两组患者临床功能与影像学评估指标间的差异。结果单节段组颈椎整体ROM术前为(45.90±15.18)°,末次随访时为(46.31±13.03)°;手术节段ROM术前为(9.67±4.54)°,末次随访时为(8.63±5.34)°;手术节段Cobb角术前为(2.13±1.32)°,末次随访时为(1.23±1.92)°。双节段组颈椎整体ROM术前为(40.14±11.59)°,末次随访时为(38.33±12.31)°;手术节段ROM术前为(9.10±4.00)°,末次随访时为(6.51±4.61)°,手术节段Cobb角术前为(3.09±2.15)°,末次随访时为(0.44±4.62)°。单节段组患者JOA改善率为(69.40±36.80)%,NDI下降(12.06±8.20)%,Odom's标准优良率为91.5%。双节段组患者JOA改善率为(59.44±59.80)%,NDI下降(12.53±9.47)%,Odom's标准优良率为80.0%。单节段组患者末次随访时颈椎整体活动度优于双节段组(P<0.05),其余指标差异无统计学意义。结论单双节段Bryan颈椎人工间盘置换术用于治疗颈椎退行性疾病具有较为满意的长期疗效,单节段Bryan人工间盘置换术后远期颈椎整体活动度优于双节段Bryan人工间盘置换术。
Objective To evaluate the influence of long-term efficacy in single-level and two-level Bryan artificial disc replacement for treating cervical degenerative disease.Methods Weretrospective analyzed 101 levels in 86 patient sunderwent single-level or two-level Bryan artificial disc replacement in our hospital between December 2003 and December 2007,and followed up for more than 10 years.The mean age was(53.9±9.3)years including 51 males and 35 females.According to the number of the operation level,the patients were divided into two groups:71 levels in group of single-level and 30 levels in group of two-levels.Clinical evaluation indexes included JOA score,NDI index and Odom's standard.Radiographic evaluationindexes included theglobal and segmental range of motion(ROM),segmental COBB's angle.Results The preoper ative global ROM was(45.90±15.18)°,and was(46.31±13.03)°at last fellow-up.The preoperative segmental ROM was(9.67±4.54)°and was(8.63±5.34)°at last follow-up.The preoperative segmental COBB's angle was(2.13±1.32)°,and was(1.23±1.92)°at last fellow-up.The preoper ative global ROM was(40.14±11.59)°,and was(38.33±12.31)°at last fellow-up.The preoperative segmental ROM was(9.10±4.00)°,and was(6.51±4.61)°at last fellow-up.The preoperative segmental COBB's angle was(3.09±2.15)°,and was(0.44±4.62)°at last fellow-up.In single-level group,the improvement rate of JOA score was(69.40±36.80)%,NDI decreased by(12.06±8.20)% and the satisfaction rate of Odom's standard was 91.5%.In two-level group,the improvement rate of JOA score was(59.44±59.80)%,NDI% decreased by(12.53±9.47)% and the satisfaction rate of Odom's standard was 80.0%.The global ROM in single-level group was higher than two-level group(P<0.05).The difference of other indexes was not statistically significantin two groups.Conclusion Both single-level and two-level Bryan cervical artificial disc replacement have the satisfied long-term efficacy in treating cervical degenerative diseases,the postoperative global ROM after long-term of single-level group is higher than those of two-level group.
Objective To evaluate the influence of long-term efficacy in single-level and two-level Bryan artificial disc replacement for treating cervical degenerative disease.Methods Weretrospective analyzed 101 levels in 86 patient sunderwent single-level or two-level Bryan artificial disc replacement in our hospital between December 2003 and December 2007,and followed up for more than 10 years.The mean age was(53.9±9.3)years including 51 males and 35 females.According to the number of the operation level,the patients were divided into two groups:71 levels in group of single-level and 30 levels in group of two-levels.Clinical evaluation indexes included JOA score,NDI index and Odom's standard.Radiographic evaluationindexes included theglobal and segmental range of motion(ROM),segmental COBB's angle.Results The preoper ative global ROM was(45.90±15.18)°,and was(46.31±13.03)°at last fellow-up.The preoperative segmental ROM was(9.67±4.54)°and was(8.63±5.34)°at last follow-up.The preoperative segmental COBB's angle was(2.13±1.32)°,and was(1.23±1.92)°at last fellow-up.The preoper ative global ROM was(40.14±11.59)°,and was(38.33±12.31)°at last fellow-up.The preoperative segmental ROM was(9.10±4.00)°,and was(6.51±4.61)°at last fellow-up.The preoperative segmental COBB's angle was(3.09±2.15)°,and was(0.44±4.62)°at last fellow-up.In single-level group,the improvement rate of JOA score was(69.40±36.80)%,NDI decreased by(12.06±8.20)% and the satisfaction rate of Odom's standard was 91.5%.In two-level group,the improvement rate of JOA score was(59.44±59.80)%,NDI% decreased by(12.53±9.47)% and the satisfaction rate of Odom's standard was 80.0%.The global ROM in single-level group was higher than two-level group(P<0.05).The difference of other indexes was not statistically significantin two groups.Conclusion Both single-level and two-level Bryan cervical artificial disc replacement have the satisfied long-term efficacy in treating cervical degenerative diseases,the postoperative global ROM after long-term of single-level group is higher than those of two-level group.
引文
[1]Goffin J,Van LJ,Van CF,et al.A clinical analysis of4-and 6-year follow-up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis[J].J Neurosurg-Spine,2010,12(3):261.
[2]Quan GM,Vital JM,Hansen S,et al.Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty[J].Spine,2011,36(8):639-646.
[3]Tian W,Han X,Liu B,et al.Clinical and radiographic results of cervical artificial disc arthroplasty over three years follow-up cohort study[J].Chin Med J(Engl),2010,123(21):2969-2973.
[4]Gutman G,Rosenzweig DH,Golan JD.The surgical treatment of cervical radiculopathy:meta-analysis of randomized controlled trials[J].Spine(Phila Pa1976),2018,43(6):E365-E372.
[5]Shriver MF,Lubelski D,Sharma AM,et al.Adjacent segment degeneration and disease following cervical arthroplasty:a systematic review and meta-analysis[J].Spine J,2016,16(2):168-181.
[6]Leung C,Casey AT,Goffin J,et al.Clinical significance of heterotopic ossification in cervical disc replacement:aprospective multicenter clinical trial[J].Neurosurgery,2005,57(4):759-763.
[7]Yi S,Oh J,Choi G,et al.The fate of heterotopic ossification associated with cervical artificial disc replacement.[J].Spine,2014,39(25):2078-2083.
[8]Tu TH,Wu JC,Huang WC,et al.The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty:determination by computed tomography with a minimum 2-year follow-up:Clinical article[J].J Neurosurg Spine,2012,16(6):601-609.
[9]TianW,HanX,LiuB,et al.Generation and development of paravertebral ossification in cervical artificial disk replacement:A detailed analytic report using coronal reconstruction CT[J].Clin Spine Surg,2017,30(3):179-188.
[10]Hukuda S,Mochizuki T,Ogata M,et al.Operations for cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures[J].J Bone Joint Surg(Br),1985,67(4):609-615.
[11]田伟,吕艳伟,刘亚军,等.北京市18岁以上居民颈椎病现况调查研究[J].中华骨科杂志,2012,32(8):707-713.
[12]Tian W,Yan K,Han X,et al.Comparison of the clinical and radiographic results between cervical artificial disk replacement andanterior cervical fusion:A6-year prospective nonrandomized comparative study[J].Clin Spine Surg,2017,30(5):E578.
[13]Phillips FM,Geisler FH,Gilder KM,et al.Longterm outcomes of the US FDA IDE prospective,randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion[J].Spine,2015,40(10):674-683.
[14]Luo J,Sheng H,Min G,et al.Comparison of artificial cervical arthroplasty versus anterior cervical discectomy and fusion for one-level cervical degenerative disc disease:a meta-analysis of randomized controlled trials[J].Eur J Orthop Surg Traumatol,2015,25(1):115-125.
[15]Wu AM,Xu H,Mullinix KP,et al.Minimum 4-year outcomes of cervical total disc arthroplasty versus fusion:a meta-analysis based on prospective randomized controlled trials[J].Medicine,2015,94(15):e665.
[16]Galbusera F,Bellini CM,Brayda-Bruno M,et al.Biomechanical studies on cervical total disc arthroplasty:A literature review[J].Clin Biomech,2008,23(9):1095-1104.
[17]Tian W,Wang H,Yan K,et al.Analysis of the factors that could predict segmental range of motion after cervical artificial disc replacement:A 7-years follow-up study[J].Clin Spine Surg,2017,30(5):E603-608.
[18]Wigfield CC,Gill SS,Nelson RJ,et al.The new frenchay artificial cervical joint:results from a two-year pilot study[J].Spine,2002,27(22):2446-2452.
[19]Faizan A,Goel VK,Biyani A,et al.Adjacent level effects of bi level disc replacement,bi level fusion and disc replacement plus fusion in cervical spine-a finite element based study.[J].Clin Biomech,2012,27(3):226.
[20]阎凯,马驰,韩骁,等.颈椎人工间盘置换术与颈椎前路减压融合术治疗双节段脊髓型颈椎退行性疾病的长期随访研究[J].骨科临床与研究杂志,2017,2(2):90-95.
[21]Pickett GE,Rouleau JP,Duggal N.Kinematic analysis of the cervical spine following implantation of an artificial cervical disc[J].Spine,2005,30(17):1949-1954.
[22]Fong SY,Duplessis SJ,Casha S,et al.Design limitations of bryan disc arthroplasty[J].Spine J,2006,6(3):233.
[23]Walraevens JR,Liu B,Sloten JV,et al.Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis:is it related to the mechanics and design of the prosthesis?[J].J Spinal Disord Tech,2010,23(6):372-376.
[2]Quan GM,Vital JM,Hansen S,et al.Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty[J].Spine,2011,36(8):639-646.
[3]Tian W,Han X,Liu B,et al.Clinical and radiographic results of cervical artificial disc arthroplasty over three years follow-up cohort study[J].Chin Med J(Engl),2010,123(21):2969-2973.
[4]Gutman G,Rosenzweig DH,Golan JD.The surgical treatment of cervical radiculopathy:meta-analysis of randomized controlled trials[J].Spine(Phila Pa1976),2018,43(6):E365-E372.
[5]Shriver MF,Lubelski D,Sharma AM,et al.Adjacent segment degeneration and disease following cervical arthroplasty:a systematic review and meta-analysis[J].Spine J,2016,16(2):168-181.
[6]Leung C,Casey AT,Goffin J,et al.Clinical significance of heterotopic ossification in cervical disc replacement:aprospective multicenter clinical trial[J].Neurosurgery,2005,57(4):759-763.
[7]Yi S,Oh J,Choi G,et al.The fate of heterotopic ossification associated with cervical artificial disc replacement.[J].Spine,2014,39(25):2078-2083.
[8]Tu TH,Wu JC,Huang WC,et al.The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty:determination by computed tomography with a minimum 2-year follow-up:Clinical article[J].J Neurosurg Spine,2012,16(6):601-609.
[9]TianW,HanX,LiuB,et al.Generation and development of paravertebral ossification in cervical artificial disk replacement:A detailed analytic report using coronal reconstruction CT[J].Clin Spine Surg,2017,30(3):179-188.
[10]Hukuda S,Mochizuki T,Ogata M,et al.Operations for cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures[J].J Bone Joint Surg(Br),1985,67(4):609-615.
[11]田伟,吕艳伟,刘亚军,等.北京市18岁以上居民颈椎病现况调查研究[J].中华骨科杂志,2012,32(8):707-713.
[12]Tian W,Yan K,Han X,et al.Comparison of the clinical and radiographic results between cervical artificial disk replacement andanterior cervical fusion:A6-year prospective nonrandomized comparative study[J].Clin Spine Surg,2017,30(5):E578.
[13]Phillips FM,Geisler FH,Gilder KM,et al.Longterm outcomes of the US FDA IDE prospective,randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion[J].Spine,2015,40(10):674-683.
[14]Luo J,Sheng H,Min G,et al.Comparison of artificial cervical arthroplasty versus anterior cervical discectomy and fusion for one-level cervical degenerative disc disease:a meta-analysis of randomized controlled trials[J].Eur J Orthop Surg Traumatol,2015,25(1):115-125.
[15]Wu AM,Xu H,Mullinix KP,et al.Minimum 4-year outcomes of cervical total disc arthroplasty versus fusion:a meta-analysis based on prospective randomized controlled trials[J].Medicine,2015,94(15):e665.
[16]Galbusera F,Bellini CM,Brayda-Bruno M,et al.Biomechanical studies on cervical total disc arthroplasty:A literature review[J].Clin Biomech,2008,23(9):1095-1104.
[17]Tian W,Wang H,Yan K,et al.Analysis of the factors that could predict segmental range of motion after cervical artificial disc replacement:A 7-years follow-up study[J].Clin Spine Surg,2017,30(5):E603-608.
[18]Wigfield CC,Gill SS,Nelson RJ,et al.The new frenchay artificial cervical joint:results from a two-year pilot study[J].Spine,2002,27(22):2446-2452.
[19]Faizan A,Goel VK,Biyani A,et al.Adjacent level effects of bi level disc replacement,bi level fusion and disc replacement plus fusion in cervical spine-a finite element based study.[J].Clin Biomech,2012,27(3):226.
[20]阎凯,马驰,韩骁,等.颈椎人工间盘置换术与颈椎前路减压融合术治疗双节段脊髓型颈椎退行性疾病的长期随访研究[J].骨科临床与研究杂志,2017,2(2):90-95.
[21]Pickett GE,Rouleau JP,Duggal N.Kinematic analysis of the cervical spine following implantation of an artificial cervical disc[J].Spine,2005,30(17):1949-1954.
[22]Fong SY,Duplessis SJ,Casha S,et al.Design limitations of bryan disc arthroplasty[J].Spine J,2006,6(3):233.
[23]Walraevens JR,Liu B,Sloten JV,et al.Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis:is it related to the mechanics and design of the prosthesis?[J].J Spinal Disord Tech,2010,23(6):372-376.