| 颈椎动态稳定器植入术治疗颈椎病的临床疗效观察 |
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投稿时间：2013-08-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 李忠海 |
LI Zhong-hai |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China |
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| 侯树勋 |
HOU Shu-xun |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China |
lvshunman@126.com |
| 李利 |
LI Li |
解放军总医院第一附属医院骨科, 北京 100048 |
Department of Orthopaedics, the First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China |
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| 虞舜志 |
YU Shun-zhi |
第二军医大学附属长海医院骨科, 上海 200433 |
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| 侯铁胜 |
HOU Tie-sheng |
第二军医大学附属长海医院骨科, 上海 200433 |
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| 期刊信息：《中国骨伤》2014年，第27卷，第12期，第1050-1055页 |
| DOI：10.3969/j.issn.1003-0034.2014.12.019 |
| 基金项目: |
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中文摘要:
目的: 观察颈椎动态稳定器(DCI)治疗颈椎病的早期临床疗效,探讨其应用的安全性及有效性.
方法: 自2009年6月至2011年12月,收治符合DCI植入指征的颈椎病患者19例,其中男8例,女11例;年龄35～54岁,平均43.2岁.脊髓型颈椎病5例,神经根型颈椎病14例.病变节段:C3,4 1例,C4,5 6例,C5,6 6例,C6,7 4例,C3,4 合并C5,6、C6,7 2例.19例患者均行颈前路椎间盘切除、椎管减压后DCI植入术,其中2例同时行颈前路椎体次全切除、植骨融合钢板内固定术.术前和末次随访采用改良日本骨科学会17分法(mJOA)、颈椎残障功能量表(NDI)评分、疼痛视觉模拟评分(VAS)和患者满意度(PSI)评价临床疗效.测量DCI植入节段的活动度(ROM)和椎间隙高度(DHI)以及相邻节段的ROM.采用Miyazaki颈椎间盘退变分级方法评定相邻节段椎间盘退变情况.
结果: 所有患者获得随访,时间12～42个月,平均19.8个月.mJOA评分术前13.6±1.1,末次随访16.3±1.2,平均改善率为85.0%;NDI评分术前17.1±7.4,末次随访6.1±3.9;VAS评分术前6.6±1.4,末次随访1.4±0.8;以上指标末次随访与术前比较差异均有统计学意义(P<0.05).DCI植入节段术前ROM(7.6±1.9)°,末次随访(7.8±2.1)°;C2-C7节段术前ROM(38.6±7.2)°,末次随访(39.9±6.4)°;以上指标末次随访与术前比较差异均无统计学意义 (P>0.05).DCI植入节段DHI术前(6.3±1.1) mm,末次随访(7.1±0.8) mm,差异有统计学意义 (P<0.05).随访未见异位骨化.MRI随访发现38个相邻节段中3个(8%)椎间盘退变分级加重1级,但无相关临床症状出现.
结论: 应用颈椎动态稳定器治疗颈椎病早期随访的临床效果满意,手术节段活动度得到一定的保留,相邻节段退变发生率较低,无相邻节段病发生,但仍然需要更长期的随访来进一步评价其功能和对邻近节段的影响. |
| 【关键词】颈椎病 颈椎动态稳定器 非融合技术 |
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| Clinical observation of dynamic cervical implant(DCI) internal fixation in the surgical treatment of cervical spondylosis |
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ABSTRACT
Objective: To investigate the early clinical effects and radiological outcome of dynamic cervical implant(DCI) internal fixation in treating cervical spondylosis,and evaluate its safety and efficiency.
Methods: From June 2009 to December 2011,19 patients with cervical spondylosis correspond to the indication of DCI internal fixation in the study,including 5 cases of cervical spondylotic myelopathy and 14 cases of cervical spondylotic radiculopathy. There were 8 males and 11 females,aged from 35 to 54 years with a mean of 43.2 years. Pathological segments included C3,4 in 1 case,C4,5 in 6,C5,6 in 6,C6,7 in 4,C3,4 and C5,6,C6,7 in 2. All patients were treated with anterior discectomy and decompression and DCI internal fixation,meanwhile,2 cases of them with anterior cervical corpectomy and fusion plate fixation. Clinical evaluation included Modified Japanese orthopedics association (mJOA),neck disability index (NDI),visual analogue scale (VAS) score and patient satisfaction index (PSI) at preoperation and final follow-up. Radiographic evaluation included flexion/extension lateral view at operative level and adjacent segment. The adjacent level degeneration was analyzed according to Miyazaki classification on MRI images.
Results: All patients were followed up from 12 to 42 months with an average of 19.8 months. Preoperative mJOA score was 13.6±1.1 and at final follow-up was 16.3±1.2 with improvement rate of 85.0%. Preoperative VAS,NDI was 6.6±1.4,17.1±7.4 and at final follow-up was 1.4± 0.8,6.1±3.9,respectively;there was statistical significance in all above-mentioned results between preoperative and final follow-up(P<0.05). Preoperative ROM at operation level was (7.6±1.9)° and final follow-up was (7.8±2.1)°; Preoperative ROM at C2-C7 was (38.6±7.2)° and final follow-up was (39.9±6.4)°;there was no statistical significance in all above-mentioned results between preoperative and final follow-up (P>0.05). Preoperative DHI at operation level was(6.3±1.1) mm and final follow-up was (7.1±0.8) mm,there was statistical significance in DHI between preoperative and final follow-up (P<0.05). No heterotopic ossification was found. All patients followed up MRI,degeneration of 3 segments aggravated 1 degree in 38 adjacent segments,without clinical symptom.
Conclusion: Treatment of cervical spondylosis with dynamic cervical implant can got satisfactory outcome in early follow-up. Activity of operative segment obtain reservation in some degree. The incidence of adjacent segment degeneration is lower and no adjacent segment disease occur. Nevertheless a longer follow-up time should be needed to assess the long term functionality of the DCI and the influence on adjacent levels. |
| KEY WORDS Cervical spondylosis Dynamic cervical implant(DCI) Nonfusion technique |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李忠海,侯树勋,李利,虞舜志,侯铁胜.颈椎动态稳定器植入术治疗颈椎病的临床疗效观察[J].中国骨伤,2014,27(12):1050~1055 |
| 英文格式: | LI Zhong-hai,HOU Shu-xun,LI Li,YU Shun-zhi,HOU Tie-sheng.Clinical observation of dynamic cervical implant(DCI) internal fixation in the surgical treatment of cervical spondylosis[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(12):1050~1055 |
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