背景：颈前路椎间盘切除植骨融合是目前治疗退变性颈椎病手术方案中的“金标准”。但随着手术病例和临床长期随访资料的增加，相关的问题也开始暴露出来。颈椎间盘置换在治疗颈椎病方面近期疗效已得到业界公认，但中远期疗效尚不明确。n 目的：比较颈前路椎间盘切除植骨融合与Discover颈椎间盘置换治疗单节段颈椎病的临床疗效。n 方法：纳入2009年1月至2011年10月收治的经保守治疗症状无明显缓解或加重的单节段颈椎病71例患者，随机分为置换组34例和融合组37例，分别进行Discover颈椎间盘置换与颈前路椎间盘切除植骨融合治疗，分别于修复前，修复后3，6，12，24，48个月及末次随访时对患者进行疼痛目测类比评分、日本矫形外科协会评分、颈椎功能障碍指数评分及影像学评估，同时记录随访期间的并发症及再次修复情况。n 结果与结论：患者71例均获得平均33.5个月的随访。两组患者修复后各随访时间点的颈痛目测类比评分、上肢痛目测类比评分、日本矫形外科协会评分、颈椎功能障碍指数评分与修复前比较均有所改善(P<0.05)，在修复后3，6，12，24个月，置换组上述指标均优于融合组(P<0.05)。修复后各时间点置换组的修复节段活动度和颈椎整体活动度均较融合组大(P<0.05)。两组患者围手术期均无严重血管神经并发症发生，在随访期间，置换组有3例出现异位骨化，1例假体有<3 mm前移；翻修2例，均因头侧邻近间隙退变、椎间盘突出压迫脊髓。融合组有3例假关节形成融合失败，1例螺钉断裂，3例因头侧邻近间隙退变存在神经症状，2例因尾侧邻近间隙退变压迫脊髓，9例均行再次修复治疗。结果提示，在治疗单节段颈椎病中期疗效方面， Discover人工颈椎间盘置换优于颈前路椎间盘切除植骨融合。%BACKGROUND:Anterior cervical discectomy and fusion is the gold stanard for the surgical treatment of n degenerative cervical disease. However, with the increasing numer of cases and long-term clinical fol ow-up data, more and more negative problems happen. The short-term clinical outcomes of cervical disc arthroplasty in the treatment of single-level cervical spondylosis have been recognized, but the mid-and long-term effects are stil unclear. n OBJECTIVE:To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Discover cervical disc arthroplasty in the treatment of single-level cervical spondylosis. n METHODS:From January 2009 to October 2011, 71 patients with single-level cervical disc disease, ineffective by conservative therapy, were randomly divided into arthroplasty group (n=34) and fusion group (n=37), receiving Discover cervical disc arthroplasty and anterior cervical discectomy and fusion, respectively. Al patients were determined with Visual Analogue Scale (VAS) score, Japanese Orthopedics Association (JOA) score, Neck Disability Index (NDI) score and radiographic examinations before surgery, at 3, 6, 12, 24, 48 months afte surgery, as wel as at final fol ow-up. Complications and secondary treatment were recorded during fol ow-up. n RESULTS AND CONCLUSION:The 71 patients were fol owed up for average 33.5 months. The VAS scores of neck and arm, JOA score and NDI score were significantly improved at each fol ow-up time point as compared with preoperative score in al patients (P<0.05), and these indexes were better in the arthroplasty group than in fusion at 3, 6, 12 and 24 months postoperatively (P<0.05). In the arthroplasty group, the range of motion of repairing segment and the whole activity of cervical vertebra were higher than that in the fusion group at each fol ow-up time piont postoperatively (P<0.05). None of patients experienced serious complications of neurovascular injury during perioperative period. During fol ow-up, there were 3 patients with heterotopic ossification, 1 patient with prosthesis antedisplacement (<3 mm) and 2 patients undering the revision surgery due to cranial adjacent degeneration, in the arthroplasty group. While in the fusion group, 9 patients accepted the revision surgery, with pseudarthrosis and fusion failure in 1, screw breakage in 1, cranial disc degeneration and neurological deficit in 3 and spinal cord decompression due to caudal disc degeneration in 2. The mid-term outcome of Discover cervical disc arthroplasty is better than anterior cervical discectomy and fusion in the treatment of single-level cervical spondylosis.
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