中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
44期
7083-7087
,共5页
王威%王利民%王卫东%谭洪宇%刘屹林%张书豪
王威%王利民%王衛東%譚洪宇%劉屹林%張書豪
왕위%왕이민%왕위동%담홍우%류흘림%장서호
植入物%人工假体%人工椎间盘置换%前路颈椎融合%临床疗效
植入物%人工假體%人工椎間盤置換%前路頸椎融閤%臨床療效
식입물%인공가체%인공추간반치환%전로경추융합%림상료효
背景：单节段颈椎病的融合治疗可导致邻近节段运动范围异常加大及退行性表现等并发症。近年来许学者开始探索用非融合技术来替代传统融合治疗。颈椎人工椎间盘置换作为一种新型的前路非融合方案越来越多地应用于临床，不仅取得了较好的临床效果，还能使颈椎椎体接近生理性稳定、延缓相邻节段退变以及减少并发症发生。<br> 目的：比较单节段颈人工椎间盘置换与颈前路减压融合内固定修复颈椎病的临床疗效。<br> 方法：2011年5月至2013年5月郑州大学第一附属医院收治了59例影像学显示颈椎单节段椎间盘退变压迫脊髓或神经根并与临床症状和体征相符合的单节段颈椎病患者，因治疗方式不同随机分为颈椎人工椎间盘置换组(置换组)和颈椎前路减压融合组(融合组)，其中置换组32例，融合组27例。治疗后5 d及治疗后3，6，12个月进行随访，测量脊髓功能JOA评分以及颈痛、上肢疼痛目测类比评分，观察置换节段的活动度及对相邻节段的影响。<br> 结果与结论：两组治疗后各时间段的JOA评分较治疗前增加(P<0.05)，目测类比评分较治疗前减少(P<0.05)，但两组间比较差异无显著性意义(P>0.05)。置换组治疗后置换节段活动度为(11.6±3.0)°，与治疗前(8.8±2.7)°。差异无显著性意义(P>0.05)。融合组治疗后3个月融合基本上无明显活动。随访时置换组相邻节段活动度小于融合组(P <0.05)；置换组治疗前后相邻节段活动度差异无显著性意义(P >0.05)；而融合组治疗前后差异有显著性意义(P<0.05)，治疗后活动度明显增大。提示与前路减压融合比较，颈椎人工椎间盘置换不仅能改善临床症状，恢复神经功能，还能保持颈椎置换节段的活动度和稳定性，且对手术临近节段活动度无明显影响，可有效的维持颈椎曲度。
揹景：單節段頸椎病的融閤治療可導緻鄰近節段運動範圍異常加大及退行性錶現等併髮癥。近年來許學者開始探索用非融閤技術來替代傳統融閤治療。頸椎人工椎間盤置換作為一種新型的前路非融閤方案越來越多地應用于臨床，不僅取得瞭較好的臨床效果，還能使頸椎椎體接近生理性穩定、延緩相鄰節段退變以及減少併髮癥髮生。<br> 目的：比較單節段頸人工椎間盤置換與頸前路減壓融閤內固定脩複頸椎病的臨床療效。<br> 方法：2011年5月至2013年5月鄭州大學第一附屬醫院收治瞭59例影像學顯示頸椎單節段椎間盤退變壓迫脊髓或神經根併與臨床癥狀和體徵相符閤的單節段頸椎病患者，因治療方式不同隨機分為頸椎人工椎間盤置換組(置換組)和頸椎前路減壓融閤組(融閤組)，其中置換組32例，融閤組27例。治療後5 d及治療後3，6，12箇月進行隨訪，測量脊髓功能JOA評分以及頸痛、上肢疼痛目測類比評分，觀察置換節段的活動度及對相鄰節段的影響。<br> 結果與結論：兩組治療後各時間段的JOA評分較治療前增加(P<0.05)，目測類比評分較治療前減少(P<0.05)，但兩組間比較差異無顯著性意義(P>0.05)。置換組治療後置換節段活動度為(11.6±3.0)°，與治療前(8.8±2.7)°。差異無顯著性意義(P>0.05)。融閤組治療後3箇月融閤基本上無明顯活動。隨訪時置換組相鄰節段活動度小于融閤組(P <0.05)；置換組治療前後相鄰節段活動度差異無顯著性意義(P >0.05)；而融閤組治療前後差異有顯著性意義(P<0.05)，治療後活動度明顯增大。提示與前路減壓融閤比較，頸椎人工椎間盤置換不僅能改善臨床癥狀，恢複神經功能，還能保持頸椎置換節段的活動度和穩定性，且對手術臨近節段活動度無明顯影響，可有效的維持頸椎麯度。
배경：단절단경추병적융합치료가도치린근절단운동범위이상가대급퇴행성표현등병발증。근년래허학자개시탐색용비융합기술래체대전통융합치료。경추인공추간반치환작위일충신형적전로비융합방안월래월다지응용우림상，불부취득료교호적림상효과，환능사경추추체접근생이성은정、연완상린절단퇴변이급감소병발증발생。<br> 목적：비교단절단경인공추간반치환여경전로감압융합내고정수복경추병적림상료효。<br> 방법：2011년5월지2013년5월정주대학제일부속의원수치료59례영상학현시경추단절단추간반퇴변압박척수혹신경근병여림상증상화체정상부합적단절단경추병환자，인치료방식불동수궤분위경추인공추간반치환조(치환조)화경추전로감압융합조(융합조)，기중치환조32례，융합조27례。치료후5 d급치료후3，6，12개월진행수방，측량척수공능JOA평분이급경통、상지동통목측류비평분，관찰치환절단적활동도급대상린절단적영향。<br> 결과여결론：량조치료후각시간단적JOA평분교치료전증가(P<0.05)，목측류비평분교치료전감소(P<0.05)，단량조간비교차이무현저성의의(P>0.05)。치환조치료후치환절단활동도위(11.6±3.0)°，여치료전(8.8±2.7)°。차이무현저성의의(P>0.05)。융합조치료후3개월융합기본상무명현활동。수방시치환조상린절단활동도소우융합조(P <0.05)；치환조치료전후상린절단활동도차이무현저성의의(P >0.05)；이융합조치료전후차이유현저성의의(P<0.05)，치료후활동도명현증대。제시여전로감압융합비교，경추인공추간반치환불부능개선림상증상，회복신경공능，환능보지경추치환절단적활동도화은정성，차대수술림근절단활동도무명현영향，가유효적유지경추곡도。
BACKGROUND:Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications. <br> OBJECTIVE:To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis. <br> METHODS:A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrol ed from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group (replacement group;n=32) and anterior cervical decompression and fusion group (fusion group;n=27). They were fol owed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed. <br> RESULTS AND CONCLUSION:The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores (P<0.05), while Japanese Orthopaedic Association Scores were decreased compared with preoperative scores (P<0.05). There were no significant differences between two groups (P>0.05). Range of motion of the replacement segment after treatment was (11.6±3.0)° in the replacement group, showing no significant differences as compared with before surgery (8.8±2.7)° (P>0.05). No significant activity was found at 3 months after treatment in the fusion group. During fol ow-up, the range of motion in the adjacent segments was smal er in the replacement group than in the fusion group (P<0.05). No significant difference in the range of motion in the adjacent segments was detected before and after treatment in the replacement group (P>0.05), but significant differences in the range of motion were detected before and after treatment in the fusion group (P<0.05). The range of motion was apparently increased after treatment. These findings indicated that compared with the anterior cervical decompression and fusion, cervical artificial disc replacement can not only improve the clinical symptoms, restore nerve function, but also can keep the range of motion and stability of the cervical replacement segment. Moreover, it does not have impacts on the range of motion in the segments near to the surgical wound, and can effectively maintain cervical curvature.
