CAJ | 학술논문

目的评价人工椎间盘置换术治疗颈椎退行性疾病的中期疗效,并探讨其是否可以减少邻近节段退变的发生.方法前瞻性对比分析接受颈椎人工间盘置换术(置换组,45例)与颈椎前路减压融合术(融合组,48例)治疗的颈椎退行性疾病患者的随访6年临床疗效和影像学资料.临床疗效评价指标为日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)、颈椎功能残障指数量表(neck disability index,NDI)和Odom评分.影像学评价指标为矢状位曲度、活动度、邻近节段退变.结果 28例置换组患者和35例融合组患者完成随访.两组患者末次随访的JOA评分和NDI均较术前有明显改善,组间比较差异无统计学意义.92.9％的置换组患者和97.1％的融合组患者Odom评分获得很好或较好的结果.两组患者颈椎矢状位曲度末次随访较术前均得到保持.颈椎整体活动度置换组末次随访与术前无明显差异,而融合组则是明显降低.置换组置换节段活动度术前为9.5°±3.7°,术后3个月为7.0°±3.0°,末次随访为6.6°±4.1°,末次随访较术后3个月无明显改变.邻近节段退变评估采用侧位X线片和MRI T2加权像,置换组上、下邻近节段退变均明显少于融合组.结论 Bryan人工椎间盘置换术6年的随访结果基本满意,能更好地保留颈椎生理活动及生物力学环境,从而降低邻近节段退变的发生率.
목적 평개인공추간반치환술치료경추퇴행성질병적중기료효,병탐토기시부가이감소린근절단퇴변적발생.방법 전첨성대비분석접수경추인공간반치환술(치환조,45례)여경추전로감압융합술(융합조,48례)치료적경추퇴행성질병환자적수방6년림상료효화영상학자료.림상료효평개지표위일본골과협회평분(Japanese Orthopaedic Association Scores,JOA)、경추공능잔장지수량표(neck disability index,NDI)화Odom평분.영상학평개지표위시상위곡도、활동도、린근절단퇴변.결과 28례치환조환자화35례융합조환자완성수방.량조환자말차수방적JOA평분화NDI균교술전유명현개선,조간비교차이무통계학의의.92.9％적치환조환자화97.1％적융합조환자Odom평분획득흔호혹교호적결과.량조환자경추시상위곡도말차수방교술전균득도보지.경추정체활동도치환조말차수방여술전무명현차이,이융합조칙시명현강저.치환조치환절단활동도술전위9.5°±3.7°,술후3개월위7.0°±3.0°,말차수방위6.6°±4.1°,말차수방교술후3개월무명현개변.린근절단퇴변평고채용측위X선편화MRI T2가권상,치환조상、하린근절단퇴변균명현소우융합조.결론 Bryan인공추간반치환술6년적수방결과기본만의,능경호지보류경추생리활동급생물역학배경,종이강저린근절단퇴변적발생솔.
Objective To evaluate the mid-term tollow-up results of cervical artificial disc replacement (CADR) for cervical degenerative disc disease,and to explore whether it can reduce the occurrence of adjacent segment degeneration (ASD).Methods A prospective comparative study of 93 patients who underwent CADR or anterior cervical decompression and fusion (ACDF) for cervical degenerative disc disease were conducted.All patients were followed up for more than 6 years.The Japanese Orthopaedic Association (JOA) score,neck disability index (NDI),Odom's scale,X-rays and magnetic resonance imaging (MRI) were used to evaluate the clinical and radiologic results.Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data.At final follow-up,the JOA score and NDI improved significantly in both groups.Between the two groups,there was no significant difference in terms of JOA score,NDI and Odom's scale.The sagittal alignment was well maintained in both groups.The total cervical spine range of motion (ROM) had no significant change for the CADR group,whereas,it significantly decreased for the ACDF group.The ROM at the replacement level of CADR patients decreased from 9.5° ± 3.7° before operation to 7.0° ± 3.0° 3 months after operation,and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease.Lateral radiographs and T2-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group.Conclusion The six-year follow-up results of CADR are basically satisfactory.Compared with ACDF,it could better preserve physiological motion and biomechanics of cervical spine,and reduce the incidence of ASD.