中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2014年
3期
659-661
,共3页
王卫东%王玉强%宋瑞鹏%赵亮%刘屹林%朱忠培%王利民
王衛東%王玉彊%宋瑞鵬%趙亮%劉屹林%硃忠培%王利民
왕위동%왕옥강%송서붕%조량%류흘림%주충배%왕이민
颈椎病%人工椎间盘%颈椎功能
頸椎病%人工椎間盤%頸椎功能
경추병%인공추간반%경추공능
Cervical spondylosis%Artificial disc%Cervical function
目的 对比Activ-C颈椎人工椎间盘置换和颈椎融合术后的颈椎运动学及放射学改变,观察两种术式对颈椎功能的影响.方法 手术治疗的单节段颈椎病患者92例,按照手术方法不同分为Activ-C颈椎人工椎间盘置换(ADR)和颈椎椎间融合(ACDF)两组,其中ADR组43例,ACDF组49例.对两组患者术前及术后颈椎功能障碍指数(NDI)、疼痛视觉模拟评分(VAS)、日本矫形外科协会评分(JOA)、颈椎曲度指数(CCI)、颈椎总活动度(ROM)、邻近节段活动度(MAL)进行分析.结果 所有患者均获随访,随访时间12 ～ 36个月,平均18.2个月.ADR组和ACDF组JOA评分分别由术前(8.1±0.7)分和(8.2±0.6)分升高至末次随访时的(14.9±0.8)分(P＜0.05)和(14.5 ±0.70)分(P＜0.05),VAS评分分别由术前(7.2±0.5)分和(7.4±0.3)分降低至末次随访时的(1.2±0.6)分(P＜0.05)和(2.1±0.4)分(P＜0.05),NDI评分分别由术前(51.5±28.4)分和(52.1±27.3)分降低至末次随访时的(31.4±20.3)分(P＜0.05)和(33.6±18.2)分(P＜0.05),两组之间比较差异无统计学意义(P＞0.05);CCI分别由术前(14.60±2.94)％和(14.66±3.05)％降低至末次随访时的(14.03±2.76)％ (P ＞0.05)和(12.08±2.65)％ (P ＜0.05);ACDF组ROM术后较术前有明显减少[术后末次随访(35.4±12.7)°,术前(48.2±13.8)°,P＜0.05],而ADR组与术前比较差异无统计学意义[术后末次随访(45.2±13.5)°,术前(47.7±13.4)°,P＞0.05];ACDF组术后邻近节段活动度变大[术后末次随访上一节段MAL(10.9±1.4)°、下一节段MAL(12.4±2.2)°,术前上一节段MAL(8.9±1.9)°、下一节段MAL(9.0±2.3)°,P＜0.05],显著高于ADR组[术后末次随访ADR组上一节段MAL(9.7±1.6)°、下一节段MAL(9.2±2.1)°,P＜0.05].结论 Activ-C颈人工椎间盘置换术和颈椎前路减压融合术临床疗效相近,同时保留了手术节段运动功能,手术相邻节段的活动度并无增加,并能有效维持颈椎曲度.
目的 對比Activ-C頸椎人工椎間盤置換和頸椎融閤術後的頸椎運動學及放射學改變,觀察兩種術式對頸椎功能的影響.方法 手術治療的單節段頸椎病患者92例,按照手術方法不同分為Activ-C頸椎人工椎間盤置換(ADR)和頸椎椎間融閤(ACDF)兩組,其中ADR組43例,ACDF組49例.對兩組患者術前及術後頸椎功能障礙指數(NDI)、疼痛視覺模擬評分(VAS)、日本矯形外科協會評分(JOA)、頸椎麯度指數(CCI)、頸椎總活動度(ROM)、鄰近節段活動度(MAL)進行分析.結果 所有患者均穫隨訪,隨訪時間12 ～ 36箇月,平均18.2箇月.ADR組和ACDF組JOA評分分彆由術前(8.1±0.7)分和(8.2±0.6)分升高至末次隨訪時的(14.9±0.8)分(P＜0.05)和(14.5 ±0.70)分(P＜0.05),VAS評分分彆由術前(7.2±0.5)分和(7.4±0.3)分降低至末次隨訪時的(1.2±0.6)分(P＜0.05)和(2.1±0.4)分(P＜0.05),NDI評分分彆由術前(51.5±28.4)分和(52.1±27.3)分降低至末次隨訪時的(31.4±20.3)分(P＜0.05)和(33.6±18.2)分(P＜0.05),兩組之間比較差異無統計學意義(P＞0.05);CCI分彆由術前(14.60±2.94)％和(14.66±3.05)％降低至末次隨訪時的(14.03±2.76)％ (P ＞0.05)和(12.08±2.65)％ (P ＜0.05);ACDF組ROM術後較術前有明顯減少[術後末次隨訪(35.4±12.7)°,術前(48.2±13.8)°,P＜0.05],而ADR組與術前比較差異無統計學意義[術後末次隨訪(45.2±13.5)°,術前(47.7±13.4)°,P＞0.05];ACDF組術後鄰近節段活動度變大[術後末次隨訪上一節段MAL(10.9±1.4)°、下一節段MAL(12.4±2.2)°,術前上一節段MAL(8.9±1.9)°、下一節段MAL(9.0±2.3)°,P＜0.05],顯著高于ADR組[術後末次隨訪ADR組上一節段MAL(9.7±1.6)°、下一節段MAL(9.2±2.1)°,P＜0.05].結論 Activ-C頸人工椎間盤置換術和頸椎前路減壓融閤術臨床療效相近,同時保留瞭手術節段運動功能,手術相鄰節段的活動度併無增加,併能有效維持頸椎麯度.
목적 대비Activ-C경추인공추간반치환화경추융합술후적경추운동학급방사학개변,관찰량충술식대경추공능적영향.방법 수술치료적단절단경추병환자92례,안조수술방법불동분위Activ-C경추인공추간반치환(ADR)화경추추간융합(ACDF)량조,기중ADR조43례,ACDF조49례.대량조환자술전급술후경추공능장애지수(NDI)、동통시각모의평분(VAS)、일본교형외과협회평분(JOA)、경추곡도지수(CCI)、경추총활동도(ROM)、린근절단활동도(MAL)진행분석.결과 소유환자균획수방,수방시간12 ～ 36개월,평균18.2개월.ADR조화ACDF조JOA평분분별유술전(8.1±0.7)분화(8.2±0.6)분승고지말차수방시적(14.9±0.8)분(P＜0.05)화(14.5 ±0.70)분(P＜0.05),VAS평분분별유술전(7.2±0.5)분화(7.4±0.3)분강저지말차수방시적(1.2±0.6)분(P＜0.05)화(2.1±0.4)분(P＜0.05),NDI평분분별유술전(51.5±28.4)분화(52.1±27.3)분강저지말차수방시적(31.4±20.3)분(P＜0.05)화(33.6±18.2)분(P＜0.05),량조지간비교차이무통계학의의(P＞0.05);CCI분별유술전(14.60±2.94)％화(14.66±3.05)％강저지말차수방시적(14.03±2.76)％ (P ＞0.05)화(12.08±2.65)％ (P ＜0.05);ACDF조ROM술후교술전유명현감소[술후말차수방(35.4±12.7)°,술전(48.2±13.8)°,P＜0.05],이ADR조여술전비교차이무통계학의의[술후말차수방(45.2±13.5)°,술전(47.7±13.4)°,P＞0.05];ACDF조술후린근절단활동도변대[술후말차수방상일절단MAL(10.9±1.4)°、하일절단MAL(12.4±2.2)°,술전상일절단MAL(8.9±1.9)°、하일절단MAL(9.0±2.3)°,P＜0.05],현저고우ADR조[술후말차수방ADR조상일절단MAL(9.7±1.6)°、하일절단MAL(9.2±2.1)°,P＜0.05].결론 Activ-C경인공추간반치환술화경추전로감압융합술림상료효상근,동시보류료수술절단운동공능,수술상린절단적활동도병무증가,병능유효유지경추곡도.
Objective To compare the cervical kinematics and radiographic changes after Activ-C artificial disc replacement (ADR) with anterior cervical decompression and fusion (ACDF) and analyse the effect of cervical function after the surgury.Methods A retrospective analysis of ninety-two cases with symptomatic single level cervical degenerative diseases received the surgeries.Owing to different surgeries,these patients were divided into two groups:ADR and ACDF.43 patients underwent ADR and 49 patients underwent ACDF.Nneck disability index (NDI),visual analog scale (VAS),Japanese Orthopaedic Association (JOA),cervical curvature index (CCI),range of motion (ROM) and activity of adjacent segments (MAL) during follow-up were observed.Results All the patients were received the follow-up.The average follow-up periods were 18.2 months (range,12-36 months).The postoperative scores of the JOA (ADR group 14.9 ± 0.8 and ACDF group 14.5 ± 0.7) were significantly improved compared with preoperative scores (ADR group 8.1 ± 0.7 and ACDF group 8.2 ± 0.6) (P ＜ 0.05),while VAS (ADR group 1.2 ±0.6 and ACDF group 2.1 ±0.4) and NDI (ADR group 31.4 ±20.3 and ACDF group 33.6 ± 18.2) were decreased compared with preoperative ones (VAS:ADR group 7.2 ± 0.5 and ACDF group 7.4 ± 0.3,P ＜ 0.05) (NDI:ADR group 51.5 ± 28.4 and ACDF group 52.1 ± 27.3,P ＜ 0.05).No significant difference was found between the two groups (P ＞ 0.05).Cervical curvature after ACDF (12.08 ± 2.65) ％ were lost significantly compared to preoperative CCI (14.66 ± 3.05) ％ (P ＜ 0.05).However,this phenomenon was not present in ADR (preoperative CCI:1 (4.60 ± 2.94) ％,postoperative CCI:(14.03 ± 2.76) ％ (P ＞ 0.05).In ACDF group,ROM was significantly decreased postoperatively (preoperative ROM:(48.2 ± 13.8) °,postoperative ROM:(35.4 ± 12.7) ° (P ＜ 0.05),but in ADR group,there were no significant differences between postoperative (45.2 ± 13.5)° and preoperative (47.7 ±13.4)° ROM (P＞0.05).The MAL (preoperative MAL:lower (9.0 ±2.3)°,upper (8.9 ± 1.9)°;postoperative MAL:lower (12.4 ± 2.2) °,upper (10.9 ± 1.4) ° of the ACDF group increased obviously after operation,and it was significantly higher than the ADR group (postoperative MAL:lower (9.2 ±2.1) °,upper (9.7 ± 1.6) ° (P ＜ 0.05).Conclusion Activ-C artificial disc replacement has similar clinical efficacy comparing with ACDF.It can retain normal motion of surgical segment and cervical lordosis.But the MAL was not increased.
