背景：人工颈椎间盘置换术（CADR）的设计理念是保留手术节段活动，最大程度减少颈椎术后的生物力学环境改变。目前，CADR广泛应用于临床上已超过10年，但对于不同影像学及症状学诊断颈椎退行性疾病患者CADR术后的长期效果尚无一致的结论。 目的：探究不同影像学诊断（退行性颈椎管狭窄及颈椎间盘突出）及症状学诊断（脊髓型及神经根型）颈椎退行性疾病患者CADR术后长期随访的临床效果，试图通过术前因素分析指导CADR的适应证选择。 方法：回顾性研究2004年3月至2007年4月行Bryan人工椎间盘置换的颈椎退行性疾病患者65例，共置换椎间盘74个。男44例，女21例；手术时年龄25~70岁，平均（44.9±8.0）岁；随访时间为56.8~108.0个月，平均（78.8±12.1）个月。根据术前CT及MRI将患者的影像学诊断分为两组：退行性颈椎管狭窄症组36例及颈椎间盘突出症组29例。根据术前症状及查体将患者的症状学诊断分为三组：脊髓型组49例、神经型组14例及交感型组2例。临床效果评价指标包括JOA评分、JOA改善率和NDI指数，影像学评价指标包括手术节段术前及随访的活动度（ROM）。 结果：退行性颈椎管狭窄症组末次随访置换节段ROM为9.3°±4.0°，颈椎间盘突出症组为10.7°±4.0°，相比较无统计学差异。颈椎间盘突出症组的JOA改善率为88.9%，退行性颈椎管狭窄症组为73.9%，相比较有统计学意义（P＜0.05）。脊髓型与神经根型患者的JOA改善率无统计学差异。 结论：不同影像学诊断及症状学诊断颈椎退行性疾病患者CADR术后长期随访的临床疗效和手术节段ROM均保持良好。颈椎间盘突出症患者是CADR的最佳适应证，脊髓型患者及退行性颈椎管狭窄症患者是CADR的相对适应证。%Background:Cervical artificial disc replacement (CADR) is designed to preserve of normal motion and biomechanics in cer-vical spine, and has been widely used to treat cervical degenerative disease for more than ten years, but there still are some debates about whether degenerative cervical canal stenosis (DCCS) patients and cervical myelopathy patients are suitable for CADR. Objective:The purpose of the study is to explore clinical results of CADR with different image diagnosis (DCCS and cervi-cal disc herniation [CDH]) and symptom diagnosis (myelopathy and radiculopathy). Methods:A total of 74 discs were implanted into 65 patients between March 2004 and April 2007. There were 44 males and 21 females with an average age of (44.9±8.0) years (range, 25-70 years). The average period of follow-up was (78.8±12.1) months (range, 56.8-108.0 months). According to preoperative CT and MRI, 36 patients were diagnosed as DCCS and 29 patients with CDH. According to patient's symptoms and physical examination, 49 patients were diagnosed as cervical my-elopathy, 14 were cervical radiculopathy and 2 were sympathetic cervical spondylosis. Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were used to assess clinical outcomes. Range of motion (ROM) of affected cer-vical segments was compared before surgery and at the last follow-up. Results:The ROM was 9.3° ± 4.0° and 10.7° ± 4.0° in DCCS and CDH patients at the last follow-up, respectively, and there was no significant difference in ROM between the patients. The improvement rate of JOA score was 88.9%and 73.9%in CDH and DCCS patients, respectively (P<0.05). However, There was no significant difference in the improvement rate of JOA score between the myelopathy and radiculopathy type patients. Conclusions:Clinical outcomes and segmental ROM can be well preserved in DCCS patients diagnosed by imaging or clini-cal symptoms during long-term follow-up. CDH is the best indication for CADR. DCCS and cervical myelopathy are also indicated for CADR.
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