摘要目的 探讨颈椎人工间盘置换术对颈椎间盘突出症与退行性颈椎管狭窄症的长期临床疗效.方法 回顾性分析北京积水潭医院2003年12月至2007年12月行单节段Bryan人工间盘置换术且随访超过10年的患者68例的临床资料;患者男性43例,女性25例,年龄(46 ±8)岁.依据术前CT及MRI结果将患者分为2组:颈椎间盘突出症组(27例)和退行性颈椎管狭窄症组(41例).比较两组术前及末次随访时评估的临床功能指标[日本骨科协会评分(JOA)、颈椎功能障碍指数(NDI)及Odom评分]和影像学指标(手术节段活动度、颈椎整体活动度、手术节段COBB角).连续变量数据使用独立样本t检验进行统计分析.结果 颈椎间盘突出症组JOA改善率为83％±22％,NDI％下降14％±9％,Odom评分为优者17例、良10例;退行性颈椎管狭窄症组JOA改善率为68％±34％,NDI％下降11％ ±7％,Odom评分为优者19例、良18例、可4例.颈椎间盘突出症组末次随访时手术节段活动度为10°±4°,退行性颈椎管狭窄症组为7°±6°,两组差异有统计学意义(t=2.284,P=0.026).颈椎间盘突出症组末次随访时颈椎整体活动度为50°±9°,退行性颈椎管狭窄症组为44°±14°,两组差异有统计学意义(=2.112,P=0.038).结论 颈椎人工间盘置换术对颈椎退行性疾病有满意的长期疗效,颈椎间盘突出症术后颈椎整体活动度和手术节段活动度的保留均优于退行性颈椎管狭窄症患者.

abstractsObjective To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis.Methods Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed.There were 43 males and 25 females with a mean age of (46 ± 8) years.According to preoperative CT and MRI,the patients were divided into two groups:27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group.The evaluation indexes before surgery and at last follow-up were compared between two groups.The clinical indexes included Japanese Orthopaedic Association (JOA) score,neck disability index (NDI) and Odom's grade;and the radiological indexes included the global and segmental range of motion (ROM),Cobb's angle at operated level.The continuous variable data were analyzed by independent sample t test.Results In cervical disc herniation group,the improvement rate of JOA score was 83％ ± 22％,NDI％ decreased by 14％ ± 9％,and Odom's grade was excellent in 17 patients,good in 10 patients.In degenerative cervical canal stenosis group,the improvement rate of JOA was 68％ ± 34％,NDI％ decreased by 11％ ± 7％,and Odom's grade was excellent in 19 patients,good in 18 patients,fair in 4 patients.The segmental ROM was 10° ±4° and 7° ±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t =2.284,P =0.026).The global ROM was 50° ±9° and 44° ± 14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t =2.112,P =0.038).Conclusions Cervical artificial disc replacement has a favorable longterm efficacy in treating cervical degenerative diseases.The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.