人工颈椎间盘置换术治疗神经根型颈椎病远期疗效观察
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摘要
目的探讨人工颈椎间盘置换术(cervical artificial disc replacement,CADR)治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的远期疗效及影响因素。方法回顾分析2003年12月—2007年12月行Bryan假体CADR治疗的29例CSR患者10年以上随访资料。其中男16例,女13例;年龄40～70岁,平均54.1岁。病程2～144个月,平均19.2个月。病变节段:C_(3、4) 2例,C_(4、5) 6例,C_(5、6) 18例,C_(6、7) 3例。依据术前压迫因素将患者分为两组:单纯颈椎间盘突出组14例(A组)及合并骨赘增生组15例(B组)。两组患者性别、年龄、病程、病变节段等一般资料比较差异无统计学意义(P>0.05),具有可比性。分别于术前及末次随访时评估患者影像学和临床功能指标,影像学指标包括颈椎整体活动度(range of motion,ROM)、手术节段ROM及末次随访时ROM丢失(ROM<3°)发生率、手术节段Cobb角及局部后凸发生率、椎旁骨化(paravertebral ossification,PO)分级;临床功能指标包括颈椎功能障碍指数(NDI)和整体疗效评估(采用Odom标准)。结果患者均获随访,随访时间121～153个月,平均130个月。影像学评估结果示,组内比较:除末次随访时两组手术节段Cobb角较术前显著降低(P<0.05)外,颈椎整体ROM、手术节段ROM手术前后比较差异均无统计学意义(P>0.05)。组间比较:除B组末次随访时ROM丢失发生率、高等级PO发生率显著高于A组(P<0.05)外,其余各指标两组间比较差异均无统计学意义(P>0.05)。临床功能评估结果示,A、B组末次随访时NDI均较术前显著改善(P<0.05)。A、B组手术前后NDI、末次随访时NDI降低率及Odom评分比较,差异均无统计学意义(P>0.05);两组整体疗效优良率均达100%。结论 CADR治疗CSR可获得满意的远期疗效,且单纯椎间盘突出患者术后远期手术节段ROM的保留程度优于合并骨赘增生患者。
Objective To evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement(CADR) for patients with cervical spondylotic radiculopathy(CSR). Methods The data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years(range, 40-70 years). The disease duration was 2-144 months(mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments(C_(3, 4) in 2 cases, C_(4, 5) in 6 cases, C_(5, 6) in 18 cases, C_(6, 7) in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups(P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion(ROM), loss of ROM(ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification(PO) grading. The clinical evaluation indexes included neck disability index(NDI) and overall efficacy(Odom's score). Results All patients were followed up 121-153 months(mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased(P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up(P>0.05). Except that the loss of ROM(ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A(P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups(P>0.05).The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups(P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom's score between 2 groups(P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups. Conclusion CADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.
Objective To evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement(CADR) for patients with cervical spondylotic radiculopathy(CSR). Methods The data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years(range, 40-70 years). The disease duration was 2-144 months(mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments(C_(3, 4) in 2 cases, C_(4, 5) in 6 cases, C_(5, 6) in 18 cases, C_(6, 7) in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups(P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion(ROM), loss of ROM(ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification(PO) grading. The clinical evaluation indexes included neck disability index(NDI) and overall efficacy(Odom's score). Results All patients were followed up 121-153 months(mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased(P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up(P>0.05). Except that the loss of ROM(ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A(P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups(P>0.05).The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups(P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom's score between 2 groups(P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups. Conclusion CADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.
引文
1Fraser JF,H?rtl R.Anterior approaches to fusion of the cervical spine:a metaanalysis of fusion rates.J Neurosurg Spine,2007,6(4):298-303.
2 Yue WM,Brodner W,Highland TR.Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 -to 11-year radiologic and clinical follow-up study.Spine(Phila Pa 1976),2005,30(19):2138-2144.
3van Eck CF,Regan C,Donaldson WF,et al.The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion:a study of 672 consecutive patients.Spine(Phila Pa 1976),2014,39(26):2143-2147.
4 Verma K,Gandhi SD,Maltenfort M,et al.Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion:meta-analysis of prospective studies.Spine(Phila Pa 1976),2013,38(26):2253-2257.
5Sasso WR,Smucker JD,Sasso MP,et al.Long-term clinical outcomes of cervical disc arthroplasty:a prospective,randomized,controlled trial.Spine(Phila Pa 1976),2017,42(4):209-216.
6 Liu GM,Wang YJ,Wang DS,et al.Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy:a minimum 2-year follow-up study.J Orthop Surg Res,2013,8:48.
7Skeppholm M,Lindgren L,Henriques T,et al.The Discover artificial disc replacement versus fusion in cervical radiculopathy—a randomized controlled outcome trial with 2-year follow-up.Spine J,2015,15(6):1284-1294.
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 Neurosurg Spine,2012,16(6):601-609.
9Tian W,Fan MX,Liu YJ,et al.An analysis of paravertebral ossification in cervical artificial disc replacement:a novel classification based on computed tomography.Orthop Surg,2016,8(4):440-446.
10 伍少玲,马超,伍时玲,等.颈椎功能障碍指数量表的效度与信度研究.中国康复医学杂志,2008,23(7):625-628.
11Polston DW.Cervical radiculopathy.Neurol Clin,2007,25(2):373-385.
12 Zhu L,Wei X,Wang S.Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy?A systematic review of the evidence,and a meta-analysis Clin Rehabil,2016,30(2):145-155.
13Chou R,Hashimoto R,Friedly J,et al.Epidural corticosteroid injections for radiculopathy and spinal stenosis:a systematic review and meta-analysis.Ann Intern Med,2015,163(5):373-381.
14 Gutman G,Rosenzweig DH,Golan JD.The surgical treatment of cervical radiculopathy:meta-analysis of randomized controlled trials.Spine(Phila Pa 1976),2018,43(6):E365-E372.
15韩骁,田伟,刘波,等.不同影像学及症状学诊断颈椎退行性疾病患者行人工颈椎间盘置换术的中长期随访研究.中华骨与关节外科杂志,2015,8(1):15-20.
16 Khong P,Bogduk N,Ghahreman A,et al.Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy.J Clin Neurosci,2013,20(10):1411-1416.
17Fong SY,Duplessis SJ,Casha S,et al.Design limitations of Bryan disc arthroplasty.Spine J,2006,6(3):233-241.
2 Yue WM,Brodner W,Highland TR.Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 -to 11-year radiologic and clinical follow-up study.Spine(Phila Pa 1976),2005,30(19):2138-2144.
3van Eck CF,Regan C,Donaldson WF,et al.The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion:a study of 672 consecutive patients.Spine(Phila Pa 1976),2014,39(26):2143-2147.
4 Verma K,Gandhi SD,Maltenfort M,et al.Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion:meta-analysis of prospective studies.Spine(Phila Pa 1976),2013,38(26):2253-2257.
5Sasso WR,Smucker JD,Sasso MP,et al.Long-term clinical outcomes of cervical disc arthroplasty:a prospective,randomized,controlled trial.Spine(Phila Pa 1976),2017,42(4):209-216.
6 Liu GM,Wang YJ,Wang DS,et al.Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy:a minimum 2-year follow-up study.J Orthop Surg Res,2013,8:48.
7Skeppholm M,Lindgren L,Henriques T,et al.The Discover artificial disc replacement versus fusion in cervical radiculopathy—a randomized controlled outcome trial with 2-year follow-up.Spine J,2015,15(6):1284-1294.
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 Neurosurg Spine,2012,16(6):601-609.
9Tian W,Fan MX,Liu YJ,et al.An analysis of paravertebral ossification in cervical artificial disc replacement:a novel classification based on computed tomography.Orthop Surg,2016,8(4):440-446.
10 伍少玲,马超,伍时玲,等.颈椎功能障碍指数量表的效度与信度研究.中国康复医学杂志,2008,23(7):625-628.
11Polston DW.Cervical radiculopathy.Neurol Clin,2007,25(2):373-385.
12 Zhu L,Wei X,Wang S.Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy?A systematic review of the evidence,and a meta-analysis Clin Rehabil,2016,30(2):145-155.
13Chou R,Hashimoto R,Friedly J,et al.Epidural corticosteroid injections for radiculopathy and spinal stenosis:a systematic review and meta-analysis.Ann Intern Med,2015,163(5):373-381.
14 Gutman G,Rosenzweig DH,Golan JD.The surgical treatment of cervical radiculopathy:meta-analysis of randomized controlled trials.Spine(Phila Pa 1976),2018,43(6):E365-E372.
15韩骁,田伟,刘波,等.不同影像学及症状学诊断颈椎退行性疾病患者行人工颈椎间盘置换术的中长期随访研究.中华骨与关节外科杂志,2015,8(1):15-20.
16 Khong P,Bogduk N,Ghahreman A,et al.Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy.J Clin Neurosci,2013,20(10):1411-1416.
17Fong SY,Duplessis SJ,Casha S,et al.Design limitations of Bryan disc arthroplasty.Spine J,2006,6(3):233-241.