CAJ | 학술논문

目的分析颈椎人工椎间盘置换术患者选择与术后异位骨化形成的相关性.方法回顾性分析2003年12月至2008年12月,48例接受Bryan人工颈椎间盘置换术且随访时间超过5年的患者资料,男21例,女27例;年龄20～ 53岁,平均42岁;脊髓型颈椎病34例,神经根型颈椎病14例;单节段置换术38例,包括C3-43例、C4-55例、C5-628例、C6-72例;双节段置换术9例,包括C+5、C5-64例、C5-6、C6-75例;三节段置换术1例(C3-4 C4-5、C5-6);共59个手术节段.在术后颈椎侧位X线片上使用McAde分级法评价异位骨化形成.使用Logistic回归分析患者性别、术前手术节段活动度、置换节段脊柱功能单位曲度、置换节段与相邻节段椎间隙高度比值等因素与术后异位骨化形成的关系.对阳性结果及其选择阈值采用接受者操作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the ROC curve,AUC)进行检验和量化分析.结果 48例患者术后均获得5年以上随访,随访时间60 ～ 120个月,平均70.3个月.术后59个节段中,20个出现异位骨化,发生率为33.9％(20/59).患者性别、节段活动度、置换节段脊柱功能单位曲度和术前置换节段椎间隙高度这四方面因素中,仅术前置换节段与相邻节段椎间隙高度比值与术后异位骨化的形成具有显著相关性.通过ROC曲线分析该因素的AUC为0.813,95％置信区间为0.666 ～ 0.959,据此计算出病变节段与相邻节段椎间隙高度比值的临床最佳判断阈值为0.9.结论患者选择相关临床因素中的术前置换节段椎间隙高度与术后异位骨化形成具有相关性;针对可变旋转中心的Bryan颈椎人工椎间盘假体,术前病变节段椎间隙高度较相邻节段丢失超过10％者不适合行人工椎间盘置换术.
목적 분석경추인공추간반치환술환자선택여술후이위골화형성적상관성.방법 회고성분석2003년12월지2008년12월,48례접수Bryan인공경추간반치환술차수방시간초과5년적환자자료,남21례,녀27례;년령20～ 53세,평균42세;척수형경추병34례,신경근형경추병14례;단절단치환술38례,포괄C3-43례、C4-55례、C5-628례、C6-72례;쌍절단치환술9례,포괄C+5、C5-64례、C5-6、C6-75례;삼절단치환술1례(C3-4 C4-5、C5-6);공59개수술절단.재술후경추측위X선편상사용McAde분급법평개이위골화형성.사용Logistic회귀분석환자성별、술전수술절단활동도、치환절단척주공능단위곡도、치환절단여상린절단추간극고도비치등인소여술후이위골화형성적관계.대양성결과급기선택역치채용접수자조작특정(receiver operating characteristic,ROC)곡선급곡선하면적(area under the ROC curve,AUC)진행검험화양화분석.결과 48례환자술후균획득5년이상수방,수방시간60 ～ 120개월,평균70.3개월.술후59개절단중,20개출현이위골화,발생솔위33.9％(20/59).환자성별、절단활동도、치환절단척주공능단위곡도화술전치환절단추간극고도저사방면인소중,부술전치환절단여상린절단추간극고도비치여술후이위골화적형성구유현저상관성.통과ROC곡선분석해인소적AUC위0.813,95％치신구간위0.666 ～ 0.959,거차계산출병변절단여상린절단추간극고도비치적림상최가판단역치위0.9.결론 환자선택상관림상인소중적술전치환절단추간극고도여술후이위골화형성구유상관성;침대가변선전중심적Bryan경추인공추간반가체,술전병변절단추간극고도교상린절단주실초과10％자불괄합행인공추간반치환술.
Objective To analysis the correlation between patient selection and heterotopic ossification (HO) after cervical artificial disc replacement.Methods Data of 48 patients with cervical spondylosis (34 cervical spondylotic myelopathy and 14 nerve-root type) who had undergone Bryan cervicadisc replacement from December 2003 to December 2008 were reviewed retrospectively,and all the patients had been followed up for more than 5 years.There were 21 males and 27 females with an average age of 42 years old (range,20-53 years).There were 38 single level replacement (C3-4 3 cases,C4-5 5 cases,C5-6 28 cases,C6-7 2 cases),9 double level replacement (C4-5,C5 6 4 cases;C5-6,C6-7 5 cases) and 1 three level replacement (C3-4,C4 5,C5-6) as a total of 59 surgical segments.The occurrence of HO was defined by McAfee classification on cervical lateral X-ray.Four factors were used in patient selection including gender,range of motion (ROM) of the target level,alignment of the functional spine unit (FSU) of the index level,and the disc height ratio between surgical level and the adjacent levels.The correlation between these four factors and HO was evaluated by logistic regression.The receiver operating characteristic (ROC) curve and area under the ROC curve were used to evaluate the significant result of logistic regression and the optimal diagnostic value.Results 48 patients were all followed up for an average period of 70.3 months (range,60-120 months).The occurrence rate in this study was 33.9％ (20/59 segments).Only one factor,the disc height ratio of the target level and its adjacent levels,presented statistical correlation with HO.ROC analysis showed that the area under the ROC curve of disc height ratio was 0.813 and the optimal diagnostic threshold was 0.9.Conclusion The disc height ratio of the target level and adjacent levels was the only patient selective factor correlated with the occurrence of HO.For those with disc height loss exceeding 10％ comparing to adjacent levels,it is not indicated for cervical artificial disc replacement with Bryan prosthesis.