Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响
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摘要
目的:探讨Bryan颈椎间盘假体置换术对脊髓型颈椎病患者疗效及颈椎生物力学的影响。方法:选取2015年1月到2016年12月期间在我院接受治疗的脊髓型颈椎病患者48例,根据手术方式的不同将其分为植骨融合组(25例)和假体置换组(23例),其中植骨融合组采用颈椎前路减压植骨融合术进行治疗,假体置换组采用Bryan颈椎间盘假体置换术进行治疗。比较两组患者的日本骨科协会(JOA)颈椎评分、颈椎功能障碍指数(NDI)评分、视觉模拟疼痛量表(VAS)评分、颈椎生理曲度、颈椎活动度、手术节段活动度、上邻近节段活动度、下邻近节段活动度,并比较两组患者的并发症情况。结果:术后12个月假体置换组的NDI评分明显低于植骨融合组(P<0.05);术后6个月、术后12个月植骨融合组的颈椎活动度低于假体置换组(P<0.05);术后1个月、术后3个月、术后6个月、术后12个月假体置换组的手术节段活动度高于植骨融合组(P<0.05);术后12个月植骨融合组的上邻近节段活动度、下邻近节段活动度高于假体置换组(P<0.05);两组患者随访期间颈部轴性症状发生率比较差异有统计学意义(P<0.05)。结论:与颈椎前路减压植骨融合术比较,Bryan颈椎间盘假体置换术对脊髓型颈椎病患者的远期疗效更佳,可更好的改善患者的颈椎生物力学,降低颈部轴性症状发生率,值得临床推广应用。
Objective: To investigate the effect of Bryan cervical disc prosthesis replacement on the curative effect and the biomechanics of the cervical spine in patients with cervical spondylotic myelopathy. Methods: 48 patients with cervical spondylotic myelopathy who were treated in our hospital from January 2015 to December 2016 were selected. According to the different operation methods, they were divided into bone graft fusion group(25 cases) and prosthetic replacement group(23 cases). The bone graft fusion group was treated with anterior cervical decompression and fusion, the prosthesis replacement group was treated with Bryan cervical disc prosthesis replacement. The scores of Japanese Association for Department of orthopedics(JOA), neck disability index(NDI), visual analogue scale(VAS), cervical physiological curvature, cervical spine activity, surgical segment activity, upper adjacent segment activity,lower adjacent segment activity were compared between the two groups, and the complications of the two groups were compared.Results: The NDI score in the prosthetic replacement group at 12 month after operation was significantly lower than that of the bone graft fusion group(P<0.05). The cervical spine activity in the bone graft fusion group at 6 months, 12 months after operation were lower than those of the prosthetic replacement group(P <0.05). The surgical segment activity in the prosthetic replacement group at 1 month, 3 months, 6 months, 12 months after operation were significantly higher than those of the bone graft fusion group(P<0.05). The upper and lower adjacent segment activity in the the bone graft fusion group at 12 months after operation were higher than those of the prosthetic replacement group(P<0.05). There was significant difference in the incidence of axial symptoms of patients in two groups during the follow-up period(P<0.05). Conclusion: Compare with anterior cervical decompression and fusion with bone graft, the long-term effect of Bryan cervical disc prosthesis replacement for patients with cervical spondylotic myelopathy is better, it can better improve the biomechanics of the cervical vertebra and reduce the incidence of axial symptoms in the neck, which is worthy of clinical application.
Objective: To investigate the effect of Bryan cervical disc prosthesis replacement on the curative effect and the biomechanics of the cervical spine in patients with cervical spondylotic myelopathy. Methods: 48 patients with cervical spondylotic myelopathy who were treated in our hospital from January 2015 to December 2016 were selected. According to the different operation methods, they were divided into bone graft fusion group(25 cases) and prosthetic replacement group(23 cases). The bone graft fusion group was treated with anterior cervical decompression and fusion, the prosthesis replacement group was treated with Bryan cervical disc prosthesis replacement. The scores of Japanese Association for Department of orthopedics(JOA), neck disability index(NDI), visual analogue scale(VAS), cervical physiological curvature, cervical spine activity, surgical segment activity, upper adjacent segment activity,lower adjacent segment activity were compared between the two groups, and the complications of the two groups were compared.Results: The NDI score in the prosthetic replacement group at 12 month after operation was significantly lower than that of the bone graft fusion group(P<0.05). The cervical spine activity in the bone graft fusion group at 6 months, 12 months after operation were lower than those of the prosthetic replacement group(P <0.05). The surgical segment activity in the prosthetic replacement group at 1 month, 3 months, 6 months, 12 months after operation were significantly higher than those of the bone graft fusion group(P<0.05). The upper and lower adjacent segment activity in the the bone graft fusion group at 12 months after operation were higher than those of the prosthetic replacement group(P<0.05). There was significant difference in the incidence of axial symptoms of patients in two groups during the follow-up period(P<0.05). Conclusion: Compare with anterior cervical decompression and fusion with bone graft, the long-term effect of Bryan cervical disc prosthesis replacement for patients with cervical spondylotic myelopathy is better, it can better improve the biomechanics of the cervical vertebra and reduce the incidence of axial symptoms in the neck, which is worthy of clinical application.
引文
[1]C hen Z,Wang Q,Liang M,et al.Visual cortex neural activity alteration in cervical spondylotic myelopathy patients:a resting-state f MRI study[J].Neuroradiology,2018,60(9):921-932
[2]Nouri A,Tetreault L,Zamorano JJ,et al.Role of magnetic resonance imaging in predicting surgical outcome in patients with cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2015,40(3):171-178
[3]Zhao CM,Chen Q,Zhang Y,et al.Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy:A meta-analysis[J].Medicine(Baltimore),2018,97(34):e11973
[4]Wang B,LüG,Kuang L.Anterior cervical discectomy and fusion with stand-alone anchored cages versus posterior laminectomy and fusion for four-level cervical spondylotic myelopathy:a retrospective study with 2-year follow-up[J].BMC Musculoskelet Disord,2018,19(1):216
[5]Jang SR,Lee SB,Cho KS.A Comparison of Anterior Cervical Discectomy and Fusion versus Fusion Combined with Artificial Disc Replacement for Treating 3-Level Cervical Spondylotic Disease[J].JKorean Neurosurg Soc,2017,60(6):676-683
[6]Yang X,Janssen T,Arts MP,et al.Radiological follow-up afte r implanting cervical disc prosthesis in anterior discectomy:a systematic review[J].Spine J,2018,18(9):1678-1693
[7]Lou J,Li Y,Wang B,et al.Biomechanical evaluation of cervical disc replacement with a novel prosthesis based on the physiological curvature of endplate[J].J Orthop Surg Res,2018,13(1):41
[8]Dejaegher J,Walraevens J,van Loon J,et al.10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis[J].Eur Spine J,2017,26(4):1191-1198
[9]刘瑞端,肖荣驰,唐志宏,等.单节段颈椎间盘置换术对相邻颈椎节段退变的影响[J].中国骨与关节损伤杂志,2015,30(5):452-455
[10]Hoti YUD,Aziz A,Ishaque K,et al.Clinical Outcome of Laminoplasty in Cervical Myelopathy[J].J Coll Physicians Surg Pak,2018,28(6):466-469
[11]孙永彪,艾合买提·吾买尔,赵岩,等.颈前路“杂交式”与颈后路治疗多节段脊髓型颈椎病的临床比较[J].现代生物医学进展,2017,17(22):4262-4267
[12]Nicholson KJ,Millhouse PW,Pflug E,et al.Cervical Sagittal Range of Motion as a Predictor of Symptom Severity in Cervical Spondylotic Myelopathy[J].Spine(Phila Pa 1976),2018,43(13):883-889
[13]Pepke W,Almansour H,Richter M,et al.Spondylotic cervical myelopathy:Indication of surgical treatment[J].Orthopade,2018,47(6):474-482
[14]Koyanagi I.Options of Management of the Patient with Mild Degenerative Cervical Myelopathy[J].Neurosurg Clin N Am,2018,29(1):139-144
[15]Vonck CE,Tanenbaum JE,Smith GA,et al.National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy[J].Global Spine J,2018,8(3):244-253
[16]Sielatycki JA,Chotai S,Wick J,et al.Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion[J].Spine(Phila Pa 1976),2018,43(16):1125-1132
[17]Yadav YR,Ratre S,Parihar V,et al.Endoscopic partial corpectomy using anterior decompression for cervical myelopathy[J].Neurol India,2018,66(2):444-451
[18]Shillingford J,Laratta J,Hardy N,et al.National outcomes following single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion[J].J Spine Surg,2017,3(4):641-649
[19]Qin R,Chen X,Zhou P,et al.Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament:a meta-analysis[J].Eur Spine J,2018,27(6):1375-1387
[20]Lou J,Li Y,Wang B,et al.In vitro biomechanical comparison after fixed-and mobile-core artificial cervical disc replacement versus fusion[J].Medicine(Baltimore),2017,96(41):e8291
[21]田伟,阎凯,韩骁,等.Bryan人工间盘置换与前路减压融合治疗颈椎退行性疾病的中期随访研究[J].中华骨科杂志,2013,33(2):97-104
[22]Wang T,Wang H,Liu S,et al.Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy:A meta-analysis[J].Medicine(Baltimore),2016,95(49):e5437
[23]Li Y,Fogel GR,Liao Z,et al.Finite element model predicts the biomechanical performance of cervical disc replacement and fusion hybrid surgery with various geometry of ball-and-socket artificial disc[J].Int J Comput Assist Radiol Surg,2017,12(8):1399-1409
[24]Ganbat D,Kim YH,Kim K,et al.Effect of mechanical loading on heterotopic ossification in cervical total disc replacement:a threedimensional finite element analysis[J].Biomech Model Mechanobiol,2016,15(5):1191-1199
[25]Tan LA,Riew KD,Traynelis VC.Cervical Spine Deformity-Part 1:Biomechanics,Radiographic Parameters,and Classification[J].Neurosurgery,2017,81(2):197-203
[26]Zhu Y,Tian Z,Zhu B,et al.Bryan Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Treatment of Cervical Disc Diseases:A Meta-analysis of Prospective,Randomized Controlled Trials[J].Spine(Phila Pa 1976),2016,41(12):E733-E741
[27]Badve SA,Nunley PD,Kurra S,et al.Review of long-term outcomes of disc arthroplasty for symptomatic single level cervical degenerative disc disease[J].Expert Rev Med Devices,2018,15(3):205-217
[28]Pointillart V,Castelain JE,Coudert P,et al.Outcomes of the Bryan cervical disc replacement:fifteen year follow-up[J].Int Orthop,2018,42(4):851-857
[29]Li J,Zhang D,Ding W,et al.Comparison of Clinical Outcomes After Anterior Cervical Discectomy and Fusion Versus Cervical Total Disk Replacement in Patients With Modic-2 Changes on MRI[J].Clin Spine Surg,2017,30(8):E1088-E1092
[30]Chin KR,Pencle FJR,Valdivia JM,et al.Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy:Technical note[J].J Orthop,2018,15(2):412-415
[2]Nouri A,Tetreault L,Zamorano JJ,et al.Role of magnetic resonance imaging in predicting surgical outcome in patients with cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2015,40(3):171-178
[3]Zhao CM,Chen Q,Zhang Y,et al.Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy:A meta-analysis[J].Medicine(Baltimore),2018,97(34):e11973
[4]Wang B,LüG,Kuang L.Anterior cervical discectomy and fusion with stand-alone anchored cages versus posterior laminectomy and fusion for four-level cervical spondylotic myelopathy:a retrospective study with 2-year follow-up[J].BMC Musculoskelet Disord,2018,19(1):216
[5]Jang SR,Lee SB,Cho KS.A Comparison of Anterior Cervical Discectomy and Fusion versus Fusion Combined with Artificial Disc Replacement for Treating 3-Level Cervical Spondylotic Disease[J].JKorean Neurosurg Soc,2017,60(6):676-683
[6]Yang X,Janssen T,Arts MP,et al.Radiological follow-up afte r implanting cervical disc prosthesis in anterior discectomy:a systematic review[J].Spine J,2018,18(9):1678-1693
[7]Lou J,Li Y,Wang B,et al.Biomechanical evaluation of cervical disc replacement with a novel prosthesis based on the physiological curvature of endplate[J].J Orthop Surg Res,2018,13(1):41
[8]Dejaegher J,Walraevens J,van Loon J,et al.10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis[J].Eur Spine J,2017,26(4):1191-1198
[9]刘瑞端,肖荣驰,唐志宏,等.单节段颈椎间盘置换术对相邻颈椎节段退变的影响[J].中国骨与关节损伤杂志,2015,30(5):452-455
[10]Hoti YUD,Aziz A,Ishaque K,et al.Clinical Outcome of Laminoplasty in Cervical Myelopathy[J].J Coll Physicians Surg Pak,2018,28(6):466-469
[11]孙永彪,艾合买提·吾买尔,赵岩,等.颈前路“杂交式”与颈后路治疗多节段脊髓型颈椎病的临床比较[J].现代生物医学进展,2017,17(22):4262-4267
[12]Nicholson KJ,Millhouse PW,Pflug E,et al.Cervical Sagittal Range of Motion as a Predictor of Symptom Severity in Cervical Spondylotic Myelopathy[J].Spine(Phila Pa 1976),2018,43(13):883-889
[13]Pepke W,Almansour H,Richter M,et al.Spondylotic cervical myelopathy:Indication of surgical treatment[J].Orthopade,2018,47(6):474-482
[14]Koyanagi I.Options of Management of the Patient with Mild Degenerative Cervical Myelopathy[J].Neurosurg Clin N Am,2018,29(1):139-144
[15]Vonck CE,Tanenbaum JE,Smith GA,et al.National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy[J].Global Spine J,2018,8(3):244-253
[16]Sielatycki JA,Chotai S,Wick J,et al.Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion[J].Spine(Phila Pa 1976),2018,43(16):1125-1132
[17]Yadav YR,Ratre S,Parihar V,et al.Endoscopic partial corpectomy using anterior decompression for cervical myelopathy[J].Neurol India,2018,66(2):444-451
[18]Shillingford J,Laratta J,Hardy N,et al.National outcomes following single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion[J].J Spine Surg,2017,3(4):641-649
[19]Qin R,Chen X,Zhou P,et al.Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament:a meta-analysis[J].Eur Spine J,2018,27(6):1375-1387
[20]Lou J,Li Y,Wang B,et al.In vitro biomechanical comparison after fixed-and mobile-core artificial cervical disc replacement versus fusion[J].Medicine(Baltimore),2017,96(41):e8291
[21]田伟,阎凯,韩骁,等.Bryan人工间盘置换与前路减压融合治疗颈椎退行性疾病的中期随访研究[J].中华骨科杂志,2013,33(2):97-104
[22]Wang T,Wang H,Liu S,et al.Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy:A meta-analysis[J].Medicine(Baltimore),2016,95(49):e5437
[23]Li Y,Fogel GR,Liao Z,et al.Finite element model predicts the biomechanical performance of cervical disc replacement and fusion hybrid surgery with various geometry of ball-and-socket artificial disc[J].Int J Comput Assist Radiol Surg,2017,12(8):1399-1409
[24]Ganbat D,Kim YH,Kim K,et al.Effect of mechanical loading on heterotopic ossification in cervical total disc replacement:a threedimensional finite element analysis[J].Biomech Model Mechanobiol,2016,15(5):1191-1199
[25]Tan LA,Riew KD,Traynelis VC.Cervical Spine Deformity-Part 1:Biomechanics,Radiographic Parameters,and Classification[J].Neurosurgery,2017,81(2):197-203
[26]Zhu Y,Tian Z,Zhu B,et al.Bryan Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Treatment of Cervical Disc Diseases:A Meta-analysis of Prospective,Randomized Controlled Trials[J].Spine(Phila Pa 1976),2016,41(12):E733-E741
[27]Badve SA,Nunley PD,Kurra S,et al.Review of long-term outcomes of disc arthroplasty for symptomatic single level cervical degenerative disc disease[J].Expert Rev Med Devices,2018,15(3):205-217
[28]Pointillart V,Castelain JE,Coudert P,et al.Outcomes of the Bryan cervical disc replacement:fifteen year follow-up[J].Int Orthop,2018,42(4):851-857
[29]Li J,Zhang D,Ding W,et al.Comparison of Clinical Outcomes After Anterior Cervical Discectomy and Fusion Versus Cervical Total Disk Replacement in Patients With Modic-2 Changes on MRI[J].Clin Spine Surg,2017,30(8):E1088-E1092
[30]Chin KR,Pencle FJR,Valdivia JM,et al.Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy:Technical note[J].J Orthop,2018,15(2):412-415