| Bryan颈椎间盘置换在治疗颈椎病中对颈椎曲度和置换节段的影响 |
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Received:November 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李晋玉 |
LI Jin-yu |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 贾育松 |
JIA Yu-song |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 郑晨颖 |
ZHENG Chen-ying |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 孙旗 |
SUN Qi |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 陈江 |
CHEN Jiang |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 白春晓 |
BAI Chun-xiao |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 杜丽 |
DU Li |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 马晟 |
MA Cheng |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 徐林 |
XU Lin |
北京中医药大学东直门医院骨1科, 北京 100700 |
The First Department of Orthopaedics, Dongzhimen Hospital, Bejing University of Traditional Chinese Medicine, Beijing 100700, China |
285110881@qq.com |
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| 期刊信息：《中国骨伤》2018年31卷，第8期，第751-756页 |
| DOI：10.3969/j.issn.1003-0034.2018.08.013 |
| 基金项目:国家自然科学基金项目（编号：81503601） |
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目的：探讨Bryan颈椎间盘置换在治疗颈椎病中对颈椎曲度和置换节段的影响，并分析其临床疗效。
方法：对2010年8月至2013年8月行Bryan人工颈椎间盘假体植入的49例患者进行回顾性分析，男26例，女23例；平均年龄48.5岁；神经根型21例，脊髓型16例，混合型12例；单节段置换21例，双节段置换28例。采用视觉疼痛模拟评分（visual analogue scale，VAS）比较手术前后的疼痛情况；根据日本骨科协会评估治疗分数（Japanese Orthopaedic Association Scores，JOA）和颈椎功能障碍指数（Neck Disability Index，NDI）评估神经功能改善状况；通过颈椎正侧屈伸位X线测量分析手术前后颈椎生理前凸曲度，脊柱功能单位（functional spinal unit，FSU）曲度，置换及邻近节段活动度，FSU活动度变化；采用Odom法进行疗效评定。
结果：所有患者获得随访，时间18.5~37.3个月，平均33.1个月。VAS、JOA、NDI评分术前分别为7.08±1.55、5.2±1.9、39.96±7.06，术后3个月分别为3.76±2.33、13.2±1.2、25.20±6.64，末次随访分别为2.80±1.50、14.3±1.6、24.24±7.89，术后3个月和末次随访较术前明显改善（P<0.05），末次随访和术后3个月比较差异无统计学意义。颈椎生理前凸曲度由术前的（10.64±4.26）°增加至末次随访时的（13.68±4.56）°，FSU曲度由术前的（5.40±0.41）°增加至末次随访时的（9.92±2.00）°（P<0.05）。术前、术后3个月、末次随访颈椎活动度为（70.84±6.17）°、（60.00±6.58）°、（71.48±4.61）°，FSU活动度为（12.00±0.49）°、（9.36±0.26）°、（12.52±0.33）°，置换节段活动度为（10.48±0.67）°、（7.24±0.34）°、（9.28±0.36）°，置换上位节段活动度为（10.52±0.60）°、（8.60±0.30）°、（10.44±0.43）°，置换下位节段活动度为（8.48±0.40）°、（6.56±0.36）°、（9.60±0.39）°，术后3个月与术前比较差异均有统计学意义（P<0.05），末次随访与术前比较差异均无统计学意义（P>0.05）。术后发生咽部不适、声音嘶哑5例，均于术后2周内恢复正常。术后6个月发现异位骨化1例，术后12个月发现假体移位1例。按照Odom评定标准，优20例，良27例，一般2例。
结论：Bryan人工颈椎间盘置换术不仅有良好临床疗效，同时重建了颈椎和FSU前凸曲度，保留了颈椎置换节段活动度，恢复了颈椎整体生物力学功能。 |
| [关键词]:颈椎病 Bryan假体 人工间盘置换 治疗结果 |
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| Effect of Bryan cervical disc replacement on cervical curvature and replacement segment in treating cervical spondylosis |
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Abstract:
Objective:To investigate the effect of Bryan cervical disc replacement on cervical curvature and replacement segment in the treatment of cervical spondylosis,and analyze its clinical efficacy.
Methods:Forty-nine patients underwent Bryan artificial cervical disc replacement from August 2010 to August 2013 were retrospectively analyzed. There were 26 males and 23 females,aged from 27 to 66 years old with an average of 48.5 years. Including 21 cases of nerve root type,16 cases of spinal cord type,12 cases of mixed type. And 21 cases were single segment replacement,28 cases were double segments replacement. Preoperative and postoperative pain was compared using visual analogue scale(VAS);cervical function was observed by Japanese Orthopedic Association Scores (JOA) and Neck Disability Index (NDI);cervical lordosis curvature,function spinal unit(FSU) curvature,activities of replacement and adjacent segment,FSU activity were measured by cervical X-rays. Clinical effects were evaluated by the Odom method.
Results:All the patients were followed up for 18.5 to 37.3 months with an average of 33.1 months. Pvoperative VAS,JOA,NDI scores were 7.08±1.55,5.2±1.9,39.96±7.06 before operation,3.76±2.33,13.20±1.20,25.20±6.64 at 3 months after operation,and 2.80±1.50,14.3±1.6,24.24±7.89 at the last follow-up. Patients at three months and the last follow-up after operation were obviously improved in their VAS,JOA,and NDI scores (P<0.05). There was no significant difference between the scores at last follow-up and 3 months after operation. Cervical lordosis changed from (10.64±4.26)° preoperatively to (13.68±4.56) ° at the last follow-up;the FSU curvature from (5.40±0.41) °to (9.92±2.00) åt the last follow-up (P<0.05). The range of motion of the cervical spine preoperatively,3 month postoperatively,and at the last follow-up were(70.84±6.17)°,(60.00±6.58)°,(71.48±4.61)°; FSU activities were(12.00±0.49)°,(9.36±0.26)°,(12.52±0.33)°;the activities of replacement segment were (10.48±0.67)°,(7.24±0.34)°,(9.28±0.36)°;the activities of upper segment of replacement were (10.52±0.60)°,(8.60±0.30)°,(10.44±0.43)°;the activities of lower segment of replacement were (8.48±0.40)°,(6.56±0.36)°,(9.60±0.39)°;there were significant differences in above items preoperatively and 3 months postoperatively(P<0.05);and there were no significant difference preoperatively and at the last follow-up(P>0.05). Pharyngeal discomfort and hoarseness occurred in 5 cases,and were recovered within 2 weeks after operation;heterotopic ossification occurred in 1 case at 6 months after operation;displacement of prosthesis occurred in 1 case at 12 months after operation. Based on Odom standard to evaluate the clinical outcome,20 cases obtained excellent results,with 27 good,2 general.
Conclusion:Bryan artificial cervical disc replacement not only generate good clinical effects,but may also restore the cervical lordosis and FSU curvature,while retaining the activities of replacement segment,and restoring overall cervical biomechanical functions. |
| KEYWORDS:Cervical spondylosis Bryan prosthesis Artificial disc replacement Treatment outcome |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李晋玉,贾育松,郑晨颖,孙旗,陈江,白春晓,杜丽,马晟,徐林.Bryan颈椎间盘置换在治疗颈椎病中对颈椎曲度和置换节段的影响[J].中国骨伤,2018,31(8):751~756 |
| 英文格式: | LI Jin-yu,JIA Yu-song,ZHENG Chen-ying,SUN Qi,CHEN Jiang,BAI Chun-xiao,DU Li,MA Cheng,XU Lin.Effect of Bryan cervical disc replacement on cervical curvature and replacement segment in treating cervical spondylosis[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):751~756 |
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