摘要目的 评估颈椎人工间盘置换术治疗退行性颈椎管狭窄症的长期疗效.方法 回顾性分析2003年12月至2007年12月间行单节段Bryan颈椎人工间盘置换术治疗退行性颈椎管狭窄症且术后随访10年以上43例患者的临床资料,男28例,女15例;年龄39～76岁,平均(56.7±8.0)岁.手术节段:C3,4节段1例,C4,5节段11例,G5,6节段26例,C6,7节段5例.根据患者的术前症状及影像学明确的压迫位置,将患者分为三组:神经根型组15例,脊髓型组10例,混合型组18例.影像学评估指标包括颈椎整体活动度(range of motion,ROM)、手术节段ROM、手术节段Cobb角.临床功能评估指标包括日本骨科协会(Japanese orthopaedic association score,JOA)评分,颈椎功能障碍指数(neck disability index,NDI)及Odom标准.三组间计量资料比较采用单因素方差分析,三组间计数资料比较采用Kruskal-WallisH检验;组内手术前后数据比较采用配对t检验.结果 脊髓型组患者末次随访时手术节段Cobb角为1.29°±1.34°(t=4.606,P=0.001)、神经根型组为0.71°±2.20°(t=2.355,P=0.034)、混合型组为0.69°±2.12°(t=3.312,P=0.004),较术前均有明显下降.脊髓型组患者末次随访时手术节段ROM为6.41°±4.87°,较术前(11.46°±5.19°)明显下降(t=3.589,P＜ 0.05),其余两组差异均无统计学意义.三组患者其余影像学指标间的差异均无统计学意义.末次随访时神经根型组JOA评分为(16.33±0.75)分(t=5.857,P＜0.001),脊髓型组为(16.00±1.05)分(t=8.337,P＜ 0.001),混合型组(14.78±1.69)分(t=4.045,P＜ 0.001);神经根型组NDI为13.07％±5.90％ (t=7.097,P＜0.001),脊髓型组为12.60％±4.22％(t=7.319,P＜ 0.001),混合型组为23.11％±14.18％(t=4.229,P＜ 0.001),均较术前明显改善.组间比较结果显示神经根型组及脊髓型组患者末次随访时JOA评分(LAD-t=3.770,4.080,P＜ 0.05)、NDI(LAD-t=2.850,2.643,P＜ 0.05)及Odom优良率(H=2.719,2.411,P＜ 0.05)均优于混合型患者.结论 颈椎人工间盘置换术治疗退行性颈椎管狭窄症满的长期疗效,其中神经根型及脊髓型患者的长期疗效优于混合型.

abstractsObjective To evaluate the long-term efficacy of cervical artificial disc replacement for patients with degenerative cervical canal stenosis.Methods All of 43 patienta underwent single level Bryan cervical artificial disc replacement for degenerative cervical canal stenosis were retrospectively analyzed with a minimum 10 years follow-up in our hospital between December 2003 and December 2007.There were 28 males and 15 females with an average age of 56.7 ± 8.0 years which ranged from 37 to 76 including 1 case of C3.4 level,11 xases of ~ level,26 cases of C~ level and 5 cases of C6,7 level.According to the symptoms and location of compression on radiograph,the patients were divided into 3 groups:15 patients in radiculopathy group,10 patients in myelopathy group and 18 patients in myeloradiculo p~hy group.Radidogical evaluation indexes include global range of motion (ROM),segmental ROM,segmental Cobb angle.Clinical evaluation indexes including Japanese Orthopaedic Association (JOA) score,neck disability index (NDI) and Odom's criteria.The variable data were analyzed by one-way ANOVA,the grading data were analyzed by Kruskal-Wallis H test.The preoperative and postoperative data were analyzed by paired t test.Results At the last follow-up,the Cobb angle of the operative segment was 1.29°±1.34°in myelopathy group(t=4.606,P=0.001),0.71°±2.20°in radiculopathy group (t=2.355,P=0.034),and 0.69°±2.12° in myeloradiculopathy group (t=3.312,P=0.004),which was significantly lower than that before operation.At the last follow-up,ROM of the operative segment in myelopathy group was 6.41 o ±4.87°,which was significantly lower than that before operation (11.46° ±5.19°,t=3.589,P＜ 0.05),and there was no significant difference in the other two groups.There was no significant difference in other imaging parameters among the three groups.JOA scores at the last follow-up were 16.33±0.75 in radiculopathy group (t=5.857,P＜ 0.001),16.00±1.05 in myelopathy group(t=8.337,P＜ 0.001) and 14.78±1.69 in radiculopathy group (t=4.045,P＜ 0.001);NDI were 13.07％±5.90％ in radiculopathy group (t=7.097,P＜ 0.001),12.60％±4.22％ in myelopathy group (t=7.319,P＜ 0.001) and 23.11％±14.18％ in radiculopathy group (t=4.229,P＜ 0.001),which were all significantly improved than those before operation.The excellent and good rate of Odom's criteria (H=2.719,2.411,P＜ 0.05),JOA (LAD-t=3.770,4.080,P＜0,05) and NDI(LAD-t=2.850,2.643,P＜ 0.05) at the last follow-up of the patients in radiculopathy group and myelopathy group were better than those of patients in myeloradiculopathy group (P＜ 0.05).Conclusion Cervical artificial disc replacement has a satisfied long-term clinical efficacy with degenerative cervical canal stenosis.The efficacy of myelopathy and radiculopathy were better than myeloradiculopathy.