CAJ | 학술논문

目的分析对比Bryan人工颈椎间盘置换术与颈前路减压植骨融合术(anterior ceryical discectomy and fusion,ACDF)治疗颈椎病的中期疗效.方法 2003年11月至2004年2月,16例患者行Bryan人工颈椎间盘置换术(A组),35例患者行ACDF(B组),于术前、出院前、术后6周、3、6、12、24个月及随后每半年一次随访,通过日本矫形外科协会(JOA)评分、简明健康状况调查表(SF-36评分)、颈椎残障功能指数(neck disability index,NDI)评定治疗效果.同期摄X线片,检测病变节段的稳定性和活动度.结果两组患者术中、术后均无严重并发症发生.所有患者均获得6年以上随访,平均73.5个月.A组术后无假体移位、脱落等并发症发生,1例发生自发融合;置换节段活动度与置换前活动度的差异无统计学意义(P＞0.05).B组术后6个月X线片示植骨全部达骨性融合.两组患者术后随访时临床症状均明显缓解,疗效满意.两组患者的JOA评分及SF-36评分、NDI,术后随访时均较术前有明显提高(P＜0.05).B组活动度较术前明显减小(P＜0.01),而A组手术前后差异无统计学意义(P＞0.05);两组术后活动度差异有统计学意义(P＜0.05).结论 Bryan人工颈椎间盘置换术疗效良好,同时还可保留颈椎病变节段活动度,减少轴性症状,为颈椎病治疗提供一种新的方法.
목적 분석대비Bryan인공경추간반치환술여경전로감압식골융합술(anterior ceryical discectomy and fusion,ACDF)치료경추병적중기료효.방법 2003년11월지2004년2월,16례환자행Bryan인공경추간반치환술(A조),35례환자행ACDF(B조),우술전、출원전、술후6주、3、6、12、24개월급수후매반년일차수방,통과일본교형외과협회(JOA)평분、간명건강상황조사표(SF-36평분)、경추잔장공능지수(neck disability index,NDI)평정치료효과.동기섭X선편,검측병변절단적은정성화활동도.결과 량조환자술중、술후균무엄중병발증발생.소유환자균획득6년이상수방,평균73.5개월.A조술후무가체이위、탈락등병발증발생,1례발생자발융합;치환절단활동도여치환전활동도적차이무통계학의의(P＞0.05).B조술후6개월X선편시식골전부체골성융합.량조환자술후수방시림상증상균명현완해,료효만의.량조환자적JOA평분급SF-36평분、NDI,술후수방시균교술전유명현제고(P＜0.05).B조활동도교술전명현감소(P＜0.01),이A조수술전후차이무통계학의의(P＞0.05);량조술후활동도차이유통계학의의(P＜0.05).결론 Bryan인공경추간반치환술료효량호,동시환가보류경추병변절단활동도,감소축성증상,위경추병치료제공일충신적방법.
Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervical disc replacement (A group), and 35 patients underwent traditional ACDF (B group) were included in the study. Patients were followed up at regular intervals. The JOA score, SF-36, neck disability index (NDI) score and the dynamic flexion-extension radiographs were used to evaluated the oucomes.Results All the patients were followed up for more than 6 years (mean, 73.5 months). There were no severe adverse events in both groups. In A group, there were no differences between postoperative and preoperative mobility of surgical segments (P＞0.05). All patients obtained bone fusions 6 month after surgery in group B.In both groups, the clinical symptoms relieved obviously after surgery. The postoperative scores of the JOA,SF-36 and NDI significantly improved compared with those of preoperative ones (P＜0.05). In B group, range of motion (ROM) was significantly decreased postoperatively (P ＜0.01); in A group, there were no significant differences between postoperative and preoperative ROM (P＞0.05). The difference between two groups regarding ROM was noted (P＜0.05). Conclusion The mid-term outcomes of Bryan cervical arthroplasty are satisfied. And the cervical arthroplasty which can maintain the mobility of the segment, and decrease the incidence of the postoperative neck axial symptoms is a viable alternative to cervical spondylopathy.