Prodisc-C人工颈椎椎间盘置换的临床疗效观察和运动功能评估

摘要

目的 通过术后随访评价Prodisc-C人工颈椎椎间盘置换术(artificial cervical disc replacement,ACDR)治疗颈椎病的临床疗效及其对颈椎置换节段、邻近节段运动功能的影响.方法 回顾性分析2009年8月～2011年2月行Prodisc-C ACDR治疗20例颈椎病患者,其中脊髓型9例、神经根型8例、混合型3例,单椎间盘置换17例、双椎间盘置换3例.患者术前行CT、MRI检查明确诊断,术前和术后定期行疼痛视觉模拟量表(visual analogue scale,VAS)和日本骨科学会(Japanese Orthopaedic Association,JOA)及摄颈椎X线片.结果 13例患者获得6～18个月随访.患者术前颈肩背疼痛、上下肢麻木、肌力减弱等不适症状均明显改善.术后VAS及JOA评分均较术前明显改善,差异有统计学意义(P＜0.01)；置换节段椎间活动度( range of motion,ROM)在术后1、3、6个月显著增大,与术前相比差异有统计学意义(P＜0.01)；在末次随访时仍大于术前,差异有统计学意义(P＜0.05)；上下位邻近节段椎间隙高度和椎间ROM与术前相比,差异无统计学意义(P＞0.05).所有病例未见假体松动、移位和异位骨化.结论 Prodisc-C ACDR短期随访疗效优良,置换节段ROM增大,邻近节段椎间隙高度和椎间ROM维持在正常水平,但远期疗效还有待进一步随访观察.%Objective To evaluate the clinical efficacy of artificial cervical disc replacement (ACDR) with Prodisc-C and its effects on the motor function of the replaced level and adjacent segments. Methods A total of 20 patients who received ACDR with Prodisc-C from April 2009 to February 2011 were retrospectively analyzed. There were 9 patients with myelopathy, 8 with radiculopa-thy, and the left 3 with both symptoms. There were 17 participators received single level replacement, and the other 3 had 2 levels replaced. All the patients received CT and MRI preoperatively for accurate diagnosis. Visual analogue scale ( VAS) scores for neck and arm pain, Japanese Orthopedic Association (JOA) scores for neck and cervical spine radiography were taken preoperatively and at the scheduled follow-up postoperatively. Results Thirteen participators were followed up for 6-18 months. The manifestations, including pain of the neck and shoulders, the numbness of the limbers and the weakness of muscle before the surgery, were alleviated dramatically. The VAS and JOA scores were significantly improved after the surgery (/P<0.01). There was significant increase in the range of motion (ROM) of the replacement segment pre- and postoperatively at 1, 3 and 6 months (P < 0.01), and so did the results at the final follow-up (P <0.05). The difference was no statistically significant in the height of intervertebral space and the ROM of the upper and lower adjacent segments before and after ACDR (P>0.05). No implant migration, loosening, translocation or heterotopic ossification were found. Conclusion ACDR with Prodisc-C displays satisfactory clinical outcomes in a short-term follow-up. It improves ROM of the replaced level, and maintains the intervertebral space height and normal ROM of adjacent segments , while its long-term benefits still need further follow-up study.