摘要
目的前瞻性对比Bryan人工颈椎椎间盘置换和颈前路椎间盘切除融合术(anterior cervical discectomy andfusion,ACDF)对颈椎病治疗的临床结果。方法 2006年8月～2009年2月连续治疗的59名单间隙脊髓型或神经根型颈椎病患者,随机分为2组:Bryan组和ACDF组。比较2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、3个月6、个月1、2个月2、4个月应用疼痛视觉模拟量表(visual analog scale,VAS)、上肢疼痛VAS、颈椎功能障碍指数(neck disability index,NDI)、影像学测量等方法进行2组的评估。结果 2组在手术时间、手术出血量及住院时间的差异无统计学意义(P>0.05)。颈痛VAS、颈部NDI术后6周、3个月2组的差异有统计学意义(P<0.05),其余各随访时间段2组差异均无统计学意义(P>0.05),但与术前相比差异有统计学意义(P<0.05)。影像学测量手术节段及整个颈椎的过伸过曲位角度变化: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;整个颈椎的屈伸范围Bryan组在各个时间段与术前相比差异无统计学意义(P>0.05),而ACDF组在术后6周3、个月与术前相比差异有统计学数(P<0.05)6,个月逐渐恢复正常。结论经过中期的临床随访,Bryan人工颈椎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ACDF相似的临床效果,而且手术后短期内治疗效果优于ACDF。
Objective To prospectively compare the clinical outcomes of Bryan artificial cervical disc replacement with anterior cervical decompression and fusion（ACDF） in treating single-level cervical spondylotic myelopathy（CSM） or radiculopathy.Methods From August 2006 to February 2009,59 consecutive patients with single-level CSM or radiculopathy were randomly assigned to receive a treatment with Bryan artificial cervical disc replacement（n=27） or ACDF（n=32）.Operation time,blood loss and hospital stay were compared between the 2 groups.Range of motion（ROM） of index level and the whole cervical spine were measured on dynamic radiographs.Visual analog scale（VAS） for neck and arm pain,neck disability index（NDI）,and radiological measurement were accessed within 2 groups at 6 weeks,and 3,6,12 and 24 months after surgery,respectively.Results There were no statistically significant differences in operation time,blood loss and hospital stay between the 2 groups（P〉0.05）.VAS for neck and arm pain and NDI were statistically significantly different between 2 groups at 6 weeks and 3 months postoperatively（P〈0.05）,and not at other time points（P〉0.05）.However,all the data were significantly different from those before surgery in both groups（P〈0.05）.ROM of index level was maintained in normal range in Bryan group and had no change in ACDF group.Compared with preoperative motion,ROM of the whole cervical spine was not significantly changed at all the time points in Bryan group（P〈0.05）,but was significantly different at 6 weeks and 3 months after surgery in ACDF group（P〉0.05）,which returned to normal gradually in 6 months postoperatively and later.Conclusion This mid-term follow-up indicates that Bryan artificial cervical disc replacement maintains normal ROM of index level,and obtains similar therapeutic effect with that of ACDF.What＇s more,Bryan replacement is superior to ACDF in regard to short-term clinical outcomes.
出处
《脊柱外科杂志》
2011年第5期263-267,共5页
Journal of Spinal Surgery
关键词
颈椎
椎间盘
人工关节
关节成形术
置换
椎间盘切除术
脊柱融合术
活动范围
关节
Cervical vertebrae
Intervertebral disk
Joint prosthesis
Arthroplasty
replacement
Diskectomy
Spinal fusion
Range of motion
articular
