CAJ | 학술논문

背景：近年来，以人工颈椎间盘置换为代表的非融合技术不断改进，在重建受累节段间盘结构和功能的基础上，使得术区节段颈椎结构显著接近天然生理系统所要求的动静态负荷应力分布，在保护退变节段椎间小关节及邻近节段颈椎结构功能及维持颈椎动态稳定性方面作用显著，表现出较节段融合技术明显的方法学优势。 　　目的：评价颈前路椎间盘切除融合与Bryan人工颈椎椎间盘置换治疗单节段间盘退变性脊髓或神经根型颈椎病的临床效果。 　　方法：纳入2010年3月至2012年3月收治的43例单节段退变的脊髓或神经根型颈椎病中老年患者，随机分为前路颈椎间盘切除加椎间植骨融合组(融合组)和Bryan人工椎间盘置换组。治疗前后通过X射线影像学检查观察颈椎整体及目标间隙上下邻近椎间活动度的变化；随访期间应用日本骨科协会评分、颈痛目测类比评分和颈椎功能障碍指数进行术后神经功能恢复评估。 　　结果与结论：所有患者术中及术后未出现神经血管损伤的并发症。人工椎间盘置换组术后整体颈椎及邻近关节活动度较融合组有所改善；术后各组患者神经功能均较术前明显改善，术后3个月人工椎间盘置换组日本骨科协会评分、颈痛目测类比评分及颈椎功能障碍指数均较融合组明显改善(P<0.05)，末次随访时除颈痛目测类比评分两组间有差异外，其余神经功能两组恢复情况相同。随访期间未见假体下沉、偏移及异位骨化现象。提示人工颈椎间盘置换能有效保持颈椎节段活动度，并对邻近节段间盘退变有一定的保护作用，中期随访可取得与融合手术相当的神经功能改善效果，非融合技术在单节段颈椎病的中短期疗效优于融合技术。
배경：근년래，이인공경추간반치환위대표적비융합기술불단개진，재중건수루절단간반결구화공능적기출상，사득술구절단경추결구현저접근천연생리계통소요구적동정태부하응력분포，재보호퇴변절단추간소관절급린근절단경추결구공능급유지경추동태은정성방면작용현저，표현출교절단융합기술명현적방법학우세。 　　목적：평개경전로추간반절제융합여Bryan인공경추추간반치환치료단절단간반퇴변성척수혹신경근형경추병적림상효과。 　　방법：납입2010년3월지2012년3월수치적43례단절단퇴변적척수혹신경근형경추병중노년환자，수궤분위전로경추간반절제가추간식골융합조(융합조)화Bryan인공추간반치환조。치료전후통과X사선영상학검사관찰경추정체급목표간극상하린근추간활동도적변화；수방기간응용일본골과협회평분、경통목측류비평분화경추공능장애지수진행술후신경공능회복평고。 　　결과여결론：소유환자술중급술후미출현신경혈관손상적병발증。인공추간반치환조술후정체경추급린근관절활동도교융합조유소개선；술후각조환자신경공능균교술전명현개선，술후3개월인공추간반치환조일본골과협회평분、경통목측류비평분급경추공능장애지수균교융합조명현개선(P<0.05)，말차수방시제경통목측류비평분량조간유차이외，기여신경공능량조회복정황상동。수방기간미견가체하침、편이급이위골화현상。제시인공경추간반치환능유효보지경추절단활동도，병대린근절단간반퇴변유일정적보호작용，중기수방가취득여융합수술상당적신경공능개선효과，비융합기술재단절단경추병적중단기료효우우융합기술。
BACKGROUND:Recently, non-fusion technology representing as artificial cervical disc replacement continues to improve. On the basis of reconstruction of disc structure and function of involved segments, cervical spine structure of surgery area segment is significantly close to dynamic and static load stress distribution required by natural physiological systems. It effects are apparent in protecting intervertebral facet joints of degenerated segment and structure and function of the cervical spine of adjacent segments and in maintaining cervical dynamic stability, which presented obvious methodological strengths compared with segmental fusion technology. OBJECTIVE:To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Bryan artificial cervical disc replacement in the treatment of single-level cervical spondylotic myelopathy or radiculopathy. METHODS:A total of 43 middle and old age patients with single-level cervical spondylotic myelopathy or radiculopathy, who were treated from March 2010 to March 2012, were enrol ed in this study. They were randomly assigned to anterior cervical discectomy and fusion group (fusion group) and Bryan artificial cervical disc replacement group. Range-of-motion of cervical overal and adjacent intervertebral area near the intervertebral space was observed with radiography. During fol ow-up, postoperative recovery of neurological function was evaluated using Japanese Orthopaedic Association scale, visual analog scale and neck disability index. RESULTS AND CONCLUSION:None patients experienced complications of neurovascular injury during and after the surgery. Range-of-motion of postoperative overal cervical vertebra and adjacent joint was improved in the Bryan artificial cervical disc replacement group compared with the fusion group. Neurological function was apparently improved after surgery in each group. At 3 months after surgery, scores of Japanese Orthopaedic Association, visual analog scale and neck disability index were significantly improved in the Bryan artificial cervical disc replacement group compared with the fusion group (P<0.05). During final fol ow-up, there were significant differences in visual analog scale scores between the two groups. Japanese Orthopaedic Association scale score and neck disability index score were similar between the two groups. During fol ow-up, no prosthesis sinking, displacement or heterotopic ossification were detected. These data indicated that artificial cervical disc replacement could effectively keep the range of motion of cervical segments and protect disc degeneration of adjacent segment. Mid-term fol ow up obtained similar improvement of neurological function of fusion surgery. The moderate-term and short-term efficacies of non-fusion technology were better than fusion technology in the treatment of single-level cervical spondylopathy.