颈椎前路减压人工颈椎间盘置换术与融合术治疗单节段颈椎间盘突出症的短期疗效比较

摘要

Background: The curative effect of anterior cervical discectomy and fusion (ACDF) is satisfactory for the patients with symptomatic cervical disc herniation. However, it can result in stress increase in adjacent segments and speed up the degen-eration of adjacent segments. Artificial cervical disc replacement (ACDR), a typical non-fusion surgical treatment, may be an alternative to ACDF for cervical disc herniation. Objective:To compare the clinical outcomes between ACDR and ACDF for single segmental cervical disc herniation. Methods:From January 2009 to February 2012, 61 patients with single segmental cervical disc herniation were treated in our hospital. Of them, 26 received Discover ACDF (arthroplasty group) and 35 underwent single-level ACDF (fusion group). Visual analogue scale (VAS) neck/arm pain score, Japanese Orthopedics Association (JOA) score and flexion-exten-sion range of motion of operative and adjacent segments were evaluated preoperatively and 1 week and 3, 6, 12, and 24 months postoperatively. Complications and secondary treatment were recorded. Results:A total of 52 patients (29 in arthroplasty group and 23 in fusion group) were followed up. The average follow-up pe-riod was 15.3 months (range, 12-24 months). The VAS scores of neck pain and upper limb pain and JOA score were signifi-cantly improved during follow up as compared with preoperative ones in all patients (P<0.05), but there was no significant difference between groups (P>0.05). In arthroplasty group, there was no significant difference in range of motion of opera-tive and adjacent segments before and after treatment (P>0.05). The rate of fusion achievement was 90.5%. In arthroplasy group, prosthesis antedisplacement (<3 mm) in 2 patients at 6 months after surgery, and cerebrospinal fluid leakage oc-curred 1 patient. In fusion group, adjacent segment disease occurred in one patient who underwent secondary operation. Conclusions:Discover cervical disc replacement is a feasible alternative to ACDF for patients with persistent symptomatic cervical disc herniation. It can reduce the incidence of compensatory motion at adjacent segments and will prevent from ad-jacent segment degeneration.%背景：颈前路椎间盘切除植骨融合术（ACDF）能够为有症状的颈椎病患者提供较好的治疗效果，但颈椎融合可导致相邻节段椎间盘内部应力增加，加速邻近节段椎间盘的退变。颈椎人工椎间盘置换术（ACDR）作为最具代表性的颈椎前路非融合技术，为颈椎间盘突出症的治疗提供了另外一种外科手段。目的：比较ACDR和ACDF治疗单节段颈椎间盘突出症的临床效果。方法：2009年1月至2012年2月，61例单节段颈椎间盘突出症患者接受Discover人工颈椎间盘置换手术（置换组，26例）或ACDF手术（融合组，35例）。分别在术前，术后1周，术后3、6、12及24个月对患者进行疼痛视觉模拟评分（VAS）、日本矫形外科协会（JOA）评分及影像学评估，同时记录患者并发症及二次手术情况。结果：最终，52例患者（融合组29例，置换组23例）获得平均15.3个月（12~24个月）随访。两组患者术后各随访时间点的颈痛、上肢痛VAS和JOA评分，较术前均有改善（P＜0.05），但两组间无显著统计学差异（P＞0.05）。置换组术后手术节段及邻近节段屈伸活动度与术前比较无统计学差异（P＞0.05）。融合组融合成功率为90.5%。置换组中2例患者术后6个月时假体有＜3 mm的前移，l例术后发生脑脊液漏。融合组中1例患者发生邻椎病并接受二次手术治疗。结论：单节段Discover人工颈椎间盘置换术和ACDF均可明显缓解颈椎间盘突出症患者的症状。间盘置换还能减少手术邻近节段代偿活动度的增加，有望预防相邻节段退变的发生。