CAJ | 학술논문

目的：评价Bryan人工间盘置换术治疗跳跃型多节段颈椎病的疗效。方法回顾性分析2002年2月至2012年5月接受Bryan间盘置换术（Bryan组）或颈前路减压植骨融合术（ACDF组）治疗的跳跃型多节段颈椎病患者相关资料。临床功能评估采用日本矫形外科协会（Japanese orthopaedic association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、疼痛视觉模拟评分（visual analoguc scale,VAS），影像学评估采用颈椎矢状位曲度、颈椎整体活动度及中间节段活动度，并于末次随访时评估邻近节段退变情况。结果49例患者随访超过24个月，Bryan组18例，ACDF组31例。两组患者性别、年龄、疾病类型等人口学资料的差异无统计学意义。两组患者术后JOA、NDI、VAS评分均较术前有明显改善。两组间各时间节点比较仅末次随访时VAS评分的差异有统计学意义。Bryan组术后轴性症状发生率、颈椎活动度和未手术节段活动度分别为11.1%、35.5°±5.9°和7.3°±1.4°，ACDF组分别为45.2%、24.5°±6.2°、10.1°±1.6°，差异均有统计学意义。Bryan组患者邻近节段无明显退变，ACDF组2例出现退变，但无需再次手术。结论应用Bryan间盘置换术治疗跳跃型多节段颈椎病，可有效改善神经功能，保留颈椎整体活动度，减少未手术节段活动度的代偿性增加，从而降低邻近节段退变及轴性症状发生率。
목적：평개Bryan인공간반치환술치료도약형다절단경추병적료효。방법회고성분석2002년2월지2012년5월접수Bryan간반치환술（Bryan조）혹경전로감압식골융합술（ACDF조）치료적도약형다절단경추병환자상관자료。림상공능평고채용일본교형외과협회（Japanese orthopaedic association，JOA）평분、경추공능장애지수（neck disability index，NDI）、동통시각모의평분（visual analoguc scale,VAS），영상학평고채용경추시상위곡도、경추정체활동도급중간절단활동도，병우말차수방시평고린근절단퇴변정황。결과49례환자수방초과24개월，Bryan조18례，ACDF조31례。량조환자성별、년령、질병류형등인구학자료적차이무통계학의의。량조환자술후JOA、NDI、VAS평분균교술전유명현개선。량조간각시간절점비교부말차수방시VAS평분적차이유통계학의의。Bryan조술후축성증상발생솔、경추활동도화미수술절단활동도분별위11.1%、35.5°±5.9°화7.3°±1.4°，ACDF조분별위45.2%、24.5°±6.2°、10.1°±1.6°，차이균유통계학의의。Bryan조환자린근절단무명현퇴변，ACDF조2례출현퇴변，단무수재차수술。결론응용Bryan간반치환술치료도약형다절단경추병，가유효개선신경공능，보류경추정체활동도，감소미수술절단활동도적대상성증가，종이강저린근절단퇴변급축성증상발생솔。
Objective To retrospectively analysis and compareabout Bryan artificial cervical disc arthroplasty with ante-rior cervical decompression and fusion (ACDF) on the clinical efficacy for“Skip”cervical spondylosis. Methods From February 2002 to May 2012, 49 cases were treated with Bryan artificial cervical disc arthroplasty (artificial cervical disc replacement surgery group, 18 cases) or anterior cervical decompression and fusion (ACDF group, 31 cases), 29 males and 20 females. Each case was evaluated at the moment of preoperatively, 3 months, 6 and 12 months and last follow-up after surgery by the Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Visual Analog Scale (VAS), Cervical sagittal curvature, the total cervical spine range of motion(ROM),middle segments of motion. MRI was also used to assess to adjacent segment disc degeneration, spinal cord compression and signal change situation. Results All patients were followed up for more than 24 months. The score of the JOA, NDI, VAS in the two groups of patients improved significantly after surgery than before surgery. In addition, the VAS score in last follow-up were significantly different between the two groups, but other index each time in the two groups showed no significant difference. In last follow-up, the result of artificial cervical disc arthroplasty group were better than ACDF group on the incidence of axial symptoms, the total cervical spine range of motion (ROM) and middle segments of motion. The incidence of axial symptoms in artificial cervical disc arthroplasty group were 11.1%,ACDF group were 45.2%. ROM in arti-ficial cervical disc arthroplasty group were 35.5°±5.9°,ACDF group were 24.5°±6.2°. Middle segments of motion in artificial cer-vical disc arthroplasty group were 7.3°±1.4°,ACDF group were 10.1°±1.6°. The above comparison of the datas were statistically different. There are two cases of adjacent segment degeneration in ACDF group without need to surgery. Conclusion Bryan artifi-cial cervical disc replacement surgery effectively retained the overall motion of the cervical spine, reduced the motion of middle segments, thus avoiding adjacent segment degeneration and the incidence of postoperative axial symptoms.