Mobi-C人工颈椎间盘置换术对颈椎曲度的影响
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摘要
目的探讨采用Mobi-C人工颈椎间盘置换术治疗颈椎退行性疾病术后对患者颈椎曲度的影响。方法回顾性分析自2009-01—2010-12经前路行椎间盘切除减压、Mobi-C人工颈椎间盘置换术治疗的25例颈椎退行性疾病,并进行了5年以上的随访观察。比较术前、术后即刻、末次随访时置换节段脊柱功能单位(FSU)曲度。结果 25例均获得随访,随访时间平均62.5(60~65)个月。术前FSU曲度为(0.28±4.69)°,术后即刻为(2.09±4.15)°,末次随访时为(1.97±4.10)°;手术前后FSU曲度差异有统计学意义(F=3.187,P=0.003),且术后即刻FSU曲度较术前明显改善(P=0.003),但末次随访时FSU曲度与术后即刻比较差异无统计学意义(P=0.044)。术前2例FSU后凸>10°(即FSU曲度<-10°),术后置换节段仍存在后凸畸形。结论采用Mobi-C假体行人工椎间盘置换术治疗颈椎退行性疾病可以部分矫正置换节段的后凸畸形,术后置换节段曲度维持良好,但对于术前FSU后凸>10°的颈椎退行性疾病患者不建议行该手术。
Objective To investigate the effect of Mobi-C cervical disc replacement on post-operative cervical spine curvature in patients with cervical degenerative disease. Methods A total of 25 cases underwent anterior cervical discectomy and Mobi-C intervertebral disc replacement of cervical spondylosis from January 2009 to December 2010, and were observed for more than 5 years. The functional spine unit(FSU) angles at operated segments were measured on lateral X-ray films before operation, immediately after operation and at follow-up. Results All 25 patients were followed up for mean 62.5 months(60-65 months). The mean preoperative FSU angle was(0.28 ±4.69)°. The mean immediately postoperative FSU angle was(2.09±4.15)°, and the mean FSU angle at final follow-up was(1.97±4.10)°. There were significant differences in mean FSU angle before operation and immediately after operation(F =3.187, P =0.003), and the FSU angle were significantly improved after operation(P =0.003). There were no significant differences in mean FSU angle immediately after operation and at final follow-up(P =0.044). But two cases with kyphosis of FSU(FSU angle <-10°) before operation still had the kyphosis in operated segments after operation. Conclusion Mobi-C intervertebral disc replacement for degenerative cervical spondylosis can partly correct kyphosis of operated segments and the curvature in operated segments can be well maintained. But the artificial disc replacement by Mobi-C prostheses is not recommended for the patients whose preoperative FSU kyphosis was over 10°.
Objective To investigate the effect of Mobi-C cervical disc replacement on post-operative cervical spine curvature in patients with cervical degenerative disease. Methods A total of 25 cases underwent anterior cervical discectomy and Mobi-C intervertebral disc replacement of cervical spondylosis from January 2009 to December 2010, and were observed for more than 5 years. The functional spine unit(FSU) angles at operated segments were measured on lateral X-ray films before operation, immediately after operation and at follow-up. Results All 25 patients were followed up for mean 62.5 months(60-65 months). The mean preoperative FSU angle was(0.28 ±4.69)°. The mean immediately postoperative FSU angle was(2.09±4.15)°, and the mean FSU angle at final follow-up was(1.97±4.10)°. There were significant differences in mean FSU angle before operation and immediately after operation(F =3.187, P =0.003), and the FSU angle were significantly improved after operation(P =0.003). There were no significant differences in mean FSU angle immediately after operation and at final follow-up(P =0.044). But two cases with kyphosis of FSU(FSU angle <-10°) before operation still had the kyphosis in operated segments after operation. Conclusion Mobi-C intervertebral disc replacement for degenerative cervical spondylosis can partly correct kyphosis of operated segments and the curvature in operated segments can be well maintained. But the artificial disc replacement by Mobi-C prostheses is not recommended for the patients whose preoperative FSU kyphosis was over 10°.
引文
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[11]Yanbin Z,Yu S,Zhongqiang C,et al.Sagittal alignment comparison of Bryan disc arthroplasty with Prodisc-C arthroplasty:a prospective,randomized controlled clinical trial[J].J Spinal Disord Tech,2011,24(6):381-385.
[12]鲍达,马远征,陈兴.Mobi-C人工颈椎间盘置换:5年19例随访报告[J].中国组织工程研究,2015,19(39):6291-6295.
[13]林斌,冯万立,郭志民,等.Bryan人工间盘置换治疗颈椎病近期疗效及并发症分析[J].实用骨科杂志,2011,17(3):193-196.
[14]Yi S,Shin HC,Kim KN,et al.Modified techniques to prevent sagittal imbalance after cervical arthroplasty[J].Spine(Phila Pa1976),2007,32(18):1986-1991.
[15]孙宇,赵衍斌,周非非,等.Bryan人工椎间盘置换术对颈椎曲度影响的研究[J].脊柱外科杂志,2011,9(5):260-262.
[16]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]尚荣安,王少飞,刘东钱,等.颈前路减压零切迹融合与钛板联合cage融合术后相邻节段退变的比较[J].中国骨与关节损伤杂志,2016,31(9):901-904.
[3]Katsuura A,Hukuda S,Saruhashi Y,et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent interventebral levels[J].Eur Spine J,2001,10(4):320-324.
[4]Lee SE,Chung CK,Jahng TA.Early development and progression of heterotopic ossification in cervical total disc replacement[J].J Neurosurg Spine,2012,16(1):31-36.
[5]Pickett GE,Mitsis DK,Sekhon LH,et al.Effects of a cervical disc prosthesis on segmental and cervical spine alignment[J].Neurosurg Focus,2004,17(3):E5.
[6]Goffin J,Van Loon J,Van Calenbergh F,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):261-269.
[7]Hacker B,Papadopoulos S,Sasso R.Bryan disc related cervical kyphosis[J].Spine J,2007,7(1):138-139.
[8]Shim CS,Shin HD,Lee SH.Posterior avulsion fracture at adjacent vertebral body during cervical disc replacement with Prodisc-C:a case report[J].J Spinal Disord Tech,2007,20(6):468-472.
[9]Suchomel P,Jurak L,Benes V 3rd,et al.Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up[J].Eur Spine J,2010,19(2):307-315.
[10]Ahn PG,Kim KN,Moon SW,et al.Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement:radiographic follow-up exceeding 2 years[J].J Neurosurg Spine,2009,11(6):688-695.
[11]Yanbin Z,Yu S,Zhongqiang C,et al.Sagittal alignment comparison of Bryan disc arthroplasty with Prodisc-C arthroplasty:a prospective,randomized controlled clinical trial[J].J Spinal Disord Tech,2011,24(6):381-385.
[12]鲍达,马远征,陈兴.Mobi-C人工颈椎间盘置换:5年19例随访报告[J].中国组织工程研究,2015,19(39):6291-6295.
[13]林斌,冯万立,郭志民,等.Bryan人工间盘置换治疗颈椎病近期疗效及并发症分析[J].实用骨科杂志,2011,17(3):193-196.
[14]Yi S,Shin HC,Kim KN,et al.Modified techniques to prevent sagittal imbalance after cervical arthroplasty[J].Spine(Phila Pa1976),2007,32(18):1986-1991.
[15]孙宇,赵衍斌,周非非,等.Bryan人工椎间盘置换术对颈椎曲度影响的研究[J].脊柱外科杂志,2011,9(5):260-262.
[16]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.