摘要目的 对Bryan人工颈椎间盘置换和前路单间隙减压融合术治疗颈椎病的临床结果 进行前瞻性对照研究.方法2003年12月至2005年5月连续治疗的59例单间隙脊髓型或神经根型颈椎病患者,随机分为Bryan人工颈椎间盘置换组(Bryan组)和前路减压融合固定组(ACDF组),比较两组手术时间、手术出血量、住院时间等临床数据,同时分别于术后6周和3、6、12、24个月应用颈痛、上肢疼痛视觉模拟评分法(VAS)、颈部功能异常评分指标(NDI)、影像学测量手术节段及整个下颈椎的过伸过曲位角度变化等方法进行疗效评估.结果 两组手术时间、手术出血量、住院时间的差异无统计学意义(P＞0.05);术后6周和3个月,两组颈痛VAS、NDI的差异有统计学意义(P＜0.05),其余随访时点两组之间的差异无统计学意义(P＞0.05),但与术前相比差异有统计学意义(P＜0.05).影像学测量:Bryan组置换节段正常活动范围存在,ACDF组置换节段无角度变化;整个下颈椎的屈伸范围,Bryan组在各个随访时段与术前相比无变化(P＞0.05),而ACDF组在术后6周和3个月与术前相比差异有统计学意义(P＜0.05),6个月时逐渐恢复正常.结论 中期随访结果显示,Bryan人工颈椎间盘置换保持了病变节段正常的屈伸活动范围,可以取得与前路减压融合固定相同的临床效果,而且手术后短期内治疗效果优于传统前路减压融合方式.

abstractsObjective To compare the clinical outcomes of single level Bryan cervical discreplacement with traditional anterior cervical discectomy and fusion(ACDF).Methods From Dec 2003 to May 2005，59 patients with primary，single-level cervical radiculopathy and/or myelopathy were prospectively randomized into 2 groups：Bryan group with artificial disc replacement and ACDF group with traditional anterior cervical discectomy and fusion.Operation time，blood loss and hospitalization duration were compared between the 2 groups.Follow-up was taken at six weeks，3，6，12 and 24 months after operation，and each case in both groups was evaluated with serial radiographic studies，neck disability indices(NDI)，visual analog scale scores(VAS)for arm and neck pain.Results No difference was found in the operation time，intraoperative blood loss and hospital stay between the 2 groups.But at the follow-up of 6 weeks and 3 months after operation，significant difference in NDI and VAS of neck pain existed.All replaced segments remained nonal range of motion in sagital rotation,while no motion occurred in any of the fusion segments.In ACDF group movement of the whole cervical spine decreased but gradually recovered to preoperative level in 6 months after operation.In Bryan group，pre-and postoperative motion of the whole cervical spine remained unchanged at any of the follow-up time.Conclusions Bryan disc replacemetn can achieve similar clinical improvement compared with traditional ACDF.Arthroplasty has the advantages of motion matainance for the cervical spine and short recovery time after operation.