摘要目的 观察人工颈椎间盘置换(CDR)术后异位骨化(HO)对患者临床疗效及相邻节段影像学参数的影响.方法 回顾性分析2008年1月至2014年3月四川大学华西医院骨科Prestige-LP假体单节段CDR手术治疗的颈椎病患者资料,将资料完整且随访在3年以上的患者纳入本研究.观察末次随访时间点HO发生情况以及HO对临床疗效指标和相邻节段椎间隙高度(IDH)、相邻节段活动度(ROM)和相邻节段退变的影响.组间数据比较采用独立样本t检验.结果 共92例患者纳入本研究,其中男48例,女44例,年龄(44±8)岁,随访(62±23)个月.末次随访34例患者发生了HO,McAfeeⅣ级HO 7例(7.6％).末次随访时,HO与无HO两组患者各项临床疗效指标均较术前获得显著改善,两组间术前及末次随访各项临床疗效指标差异均无统计学意义.两组患者术前及末次随访相邻节段IDH差异无统计学意义(t=0.596、0.825和t=0.877、0.644,均P＞0.05);两组患者术前相邻节段ROM差异无统计学(t=0.056、0.709,均P＞0.05),末次随访HO组相邻节段ROM高于无HO组(上位:10.0°±2.0°比9.0°±1.3°,下位ROM:10.2°±1.9°比8.8°±1.3°,t=2.824、4.022,均P＜0.05).HO组相邻节段退变发生率高于无HO组(41.2％比19.0％,x2=5.343,P＜0.05).结论 Prestige LP假体单节段CDR术后中长期随访发生HO是常见现象,但HO不影响患者临床症状改善.CDR术后HO可能是导致相邻节段退变加速的重要因素.

abstractsObjective To investigate the impact of heterotopic ossification (HO) after cervical disc replacement (CDR) on clinical outcome and radiological outcome of adjacent segment.Methods The data of patients underwent single-level Prestige-LP CDR between January 2008 and March 2014 in West China Hospital with a minimum 36 months of follow-up were retrospectively analyzed in this study.The incidence of HO,whether it affected clinical outcome,and its impact on adjacent segment intervertebral disc height (IDH),range of motion (ROM) and adjacent segment degeneration were observed.The data were compared with independent sample t test between the two groups.Results Ninety-two patients were included in this study,including 48 males and 44 females,the mean age was (44±8) years,and the mean follow-up was (62 ± 23) months.At the final follow-up,34 patients developed HO after CDR,but the incidence of Grade 4 HO was 7.6％.In both of the HO and non-HO groups,clinical outcomes at the final follow-up were all significantly improved when compared to those before the operation.And there was no significant differences in any clinical indexes between the HO and non-HO groups.The adjacent segment IDH before operation and at the final follow-up in the HO group and non-HO group were similar(t=0.596,0.825 and t=0.877,0.644,all P＞0.05).The preoperative adjacent segment ROM of HO group was similar with that in non-HO group(t=0.056,0.709,both P＞0.05),but the adjacent segment ROM in HO group was higher than that in the non-HO group at the final follow-up (upper adjacent segment:10.0°±2.0° vs 9.0°± 1.3°;lower adjacent segment:10.2°± 1.9° vs 8.8°± 1.3°,t=2.824,4.022,both P＜0.05).The incidence of adjacent segment degeneration of HO group was higher than that of non-HO group at the final follow-up (41.2％ vs 19.0％,x2 =5.343,P＜0.05).Conclusions HO is a common phenomenon in the long-term follow-up after the CDR operation with Prestige LP prosthesis,but HO does not affect the improvement of clinical outcome.HO after CDR might be one of important risk factors accelerating adjacent segment degeneration.