摘要
目的观察采用相邻双节段Bryan人工颈椎椎间盘置换联合双节段植骨融合术治疗多节段颈椎椎间盘突出症的中远期临床效果,并回顾置换联合融合手术(hybrid surgery,HS)的文献报道。方法 2004年12月对1例C3/C4/C5/C6/C7椎间盘突出的男性患者实施了C4/C5/C6 Bryan ACDR,C3/C4和C6/C7椎间盘切除、椎体间钛网植骨、Zephir钢板内固定术。分别于术前及术后2周、1年、2年、5年完成SF-36生活质量量表、日本骨科学会(JapaneseOrthopaedic AssociationJ,OA)评分(17分法),颈椎功能障碍指数(neck disability index,NDI)、颈部及上肢疼痛视觉模拟量表(visual analogue scale,VAS)评分;术后各随访时点行影像学检查观察Bryan人工颈椎椎间盘位置、椎间活动度、钛网和钢板的位置及植骨融合情况。结果术后2周1、年、2年随访上述各量表评分均反映临床效果良好,但术后5年随访,患者出现中等程度颈痛及双上肢麻木,其远期临床效果有所下降。随访中影像学检查示Bryan假体及钛网钢板位置均良好,Bryan假体活动度正常,植骨融合良好。结论 HS手术治疗多节段颈椎椎间盘突出症的近中期临床效果良好,远期临床效果尚可,手术安全。该术式兼顾颈椎的活动度和稳定性,为多节段颈椎椎间盘突出症的手术治疗提供了新的选择。
Objective To evaluate the mid-and long-term therapeutic effects of patient undergoing bi-level Bryan artificial cervical disc replacement（ACDR） combined with nearby segments fusion for multi-level disc herniations,and to review the literature about hybrid surgery（HS）.Methods In December 2004,a 57-year-old male patient diagnosed with disc herniation at C3/C4/C5/C6/C7 levels was treated.During the operation,the C4/C5/C6 discs were replaced with 2 Bryan artificial discs while the C3/C4 and C6/C7discs were removed,followed by the bone grafting and the Zephir instrumentation.Before the operation,and at 2 weeks,1,2 and 5 years after the operation,the clinical outcomes of the patient were evaluated by SF-36 score,Japanese Orthopaedic Association（JOA） score,neck disability index（NDI）,and visual analogue scale（VAS）.The location,stabilization and range of motion of implanted discs,the location of titanium mesh and Zephir plate,and bone graft fusion were studied and recorded by taking radiographs at each follow-up time point.Results There was no complication such as aggravation of nerve symptoms,cerebrospinal fluid leakage,hoarse voice and difficulty in swallow during follow-up.At 2 weeks after operation,SF-36 scores,JOA scores,NDI scores,and VAS scores of the neck and the upper limb were all improved.These good clinical outcomes were maintained during the first 2 years.But at 5-year follow-up,the patient suffered from moderate neck pain and anesthesia of both upper limbs.The location of artificial discs,titanium mesh and plate were perfect.The 2 discs functioned well and the nearby segments fused.Conclusion HS is safe,and its early-and mid-term clinical outcomes are excellent,but the long term results are only fairly good.HS can achieve definite stabilization and maintain ROM simultaneously,which provides an effective alternative for multi-level disc herniations.
出处
《脊柱外科杂志》
2011年第5期288-292,共5页
Journal of Spinal Surgery
关键词
颈椎
椎间盘移位
人工关节
关节成形术
置换
脊柱融合术
Cervical vertebrae
Intervertebral disk displacement
Joint prosthesis
Arthroplasty
replacement
Spinal fusion
