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术前因素对人工颈椎间盘置换术中期疗效的影响

The effect of preoperative factors on the function of the cervical spine after cervical artificial disc replacement:a minimal 3 years follow-up

摘要:

目的 探讨术前因素对Bryan人工颈椎间盘置换术中期随访治疗效果的影响.方法 对2003年12月至2006年1月实施的Bryan人工颈椎间盘置换术患者的临床资料进行回顾性分析,共50例患者61个椎间盘,其中单节段颈椎人工椎间盘置换39例,双节段颈椎人工椎问盘置换11例.评估患者病程长短、置换椎间隙高度、置换节段活动度等术前因素对末次随访疗效的影响.结果 截至2009年1月,术后36个月以上的53例患者中50例获得随访.随访时间36.0~55.6个月,呈偏态分布,中位数为41.9个月.术前神经症状时间936个月的患者JOA改善率中位数与≤3个月患者相比,差异具有统计学意义(P<0.05).术前与末次随访的置换节段活动度呈正相关(r=0.325,P<0.05).术前椎间隙高度比≤O.87的患者与>0.87的患者相比,末次随访JOA评分改善率及置换节段活动度均较低,差异具有统计学意义(P<0.05).结论 对于颈椎病及颈椎问盘突出症患者,应在神经功能障碍出现后早期行手术治疗.拟手术节段退变严重的患者,是人工椎间盘置换手术的相对禁忌.

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abstracts:

Objective To evaluate the effect of preopertative factors on the function of the cervical spine after Bryan artificial disc replacement. Methods Fifty patients who underwent cervical disc replacement from December 2003 to January 2006 were investigated. The preopertative factors such as long course of disease, lose of motion or disc height at the operation level were evaluated for their effects on the motion of the operated disc and clinical results at the time of final follow-up. There were 35 males and 15 females. Thirty-nine patients received one-level disc replacement, 11 patients received two-level disc replacement. The age of patients was from 25 to 73 years, average was 49 years. Results Until January 2009, 50 cases of all the 53 patient who got operation for more than 3 years were followed up. The follow up period was from 36. 0 to 55.6 months, which showed a skewed distribution, with a median of 41.9 months.The patients, who got neural syndrome for more than 3 years, would have worse JOA recovery rate through the surgery compared with the patients who got neural syndrome less than 3 month. As for radiographic results, the preoperative range of movement (ROM) at the implanted disc spaces was 10. 4° ± 5.0° which had significant correlation with the most recent follow-up ROM which was 8. 6°± 4. 8° ( r = 0. 325, P < 0. 05 ) . The group which height ratio of the operative disc and the adjacent discs was less than 0. 87 would have worse JOA recovery rate and range of motion at operated level at the most recent follow-up than the group more than 0. 87 with statistical significance. Conclusions For the patients with cervical spendylosis or cervical disc herniation who get nervous syndrome for more than 3 years, will have worse JOA recovery rate through the surgery, so the patient should get the operation in time to achieve better improvement. When the operated level is severe degenerated, the motion of the replaced disc and the clinical results is dissatisfied at the time of final follow-up, so it is the relative contraindications for the cervical disc replacement.

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作者: 田伟 [1] 韩骁 [1] 刘波 [1] 李勤 [1] 胡临 [1] 李志宇 [1] 袁强 [1] 何达 [1]
第一作者: 田伟
期刊: 《中华外科杂志》2010年48卷2期 108-111页 MEDLINEISTICPKUCSCD
分类号: R9
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2010.02.008
发布时间: 2010-04-06
基金项目:
北京市科技计划课题
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