人工椎间盘置换治疗外伤性颈椎椎间盘突出症的初期临床疗效

摘要

Objective To observe the preliminary outcomes of traumatic cervical hemiation treated by artificial cervical disc replacement (ACDR). Methods Clinical data of 8 patients with traumatic cervical hemiation undergoing ACDR from April 2007 to February 2011 were studied retrospectively. All the patients were assessed by clinical observation and radiological studies preoperatively, in 3 and 6 months postoperatively, and at the end of follow-up. Clinical outcome was evaluated using Japanese Orthopaedic Association (JOA) score, neck disabiliy index (NDI) criteria, and visual analog scale (VAS). Functional spinal unit range of motion (ROM) was also measured in the reontgenographs at anteroposterior and lateral, bending and extending positions. Results All cases were followed up for 6-36 months (mean 15 months). The JOA, NDI, VAS ( neck pain and arm pain) and cervical unit ROM were all significantly improved after operation ( P <0.05). No neurological or vascular complication was found in these 8 cases. The disc height and stability of cervical vertebra were maintained in the reontgenographs taken at the final follow-up. One case was found having artificial cervical prosthesis antedisplacement 1 mm 42 d after operation, and the distance of antedisplacement was not increased at the final follow-up. There was no subsidence, loosening, excursion, or heterotopic ossification in the other 7 patients. Conclusion As long as indication is correctly chosen, satisfactory outcomes will be achieved for traumatic cervical hemiation by ACDR.%目的 观察人工颈椎椎间盘置换术(artificial cervical disc replacement,ACDR)治疗外伤性颈椎椎间盘突出症的初期临床疗效.方法 对8例行ACDR的外伤性颈椎椎间盘突出症患者的临床资料进行随访分析.临床疗效评价包括术前、术后3个月、术后6个月及末次随访时的日本骨科学会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数( neck disabiliy index,NDI)评分和疼痛视觉模拟量表(visual analogue scale,VAS)评分；影像学评价包括术前、术后3个月、术后6个月及末次随访摄正侧位、动力位X线片,在X线片上测量颈椎手术节段活动度(range ofmotion,ROM).结果 所有患者经6～36个月(平均15个月)随访.术后随访各时间点的JOA评分、NDI评分、手术节段ROM以及颈痛、上肢痛的VAS评分均较术前明显改善,差异具有统计学意义(P＜0.05).均未出现神经、血管损伤并发症.末次随访X线片示椎间高度、椎间稳定性均维持良好,未发现置换节段异位骨化、假体下沉等并发症.其中1例在术后42d摄X线片时发现人工椎间盘假体前移1 mm,至末次随访时假体前移距离未明显增加；余7例未发现假体位移、松动.结论 选择合适的适应证,ACDR治疗外伤性颈椎椎间盘突出症的初期临床疗效和影像学随访结果令人满意.