中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (27): 4297-4303.doi: 10.12307/2023.384

• 人工假体 artificial prosthesis • 上一篇    下一篇

单节段Mobi-C人工间盘置换与ROI-C颈椎前路融合后颈椎矢状位参数的变化

冉  宇，白春晓，刘楚吟，赵学千，龙水文，覃昌龙，李忠泽，张  超，贾育松，陈  江   

  1. 北京中医药大学东直门医院骨伤科一区，北京市   100700
  • 收稿日期:2022-03-31 接受日期:2022-06-23 出版日期:2023-09-28 发布日期:2022-11-07
  • 通讯作者: 陈江，博士，副主任医师，硕士生导师，北京中医药大学东直门医院骨伤科一区，北京市 100700
  • 作者简介:冉宇，男，1995年生，重庆市人，汉族，北京中医药大学在读硕士，主要从事脊柱外科、数字影像学的研究。
  • 基金资助:
    国家自然科学基金重点项目(81930116)；国家自然科学基金青年项目 (81603638)，项目负责人：陈江；中国博士后科学基金 (222921)，项目负责人：陈江；北京市东城区优秀人才培养资助项目，项目负责人：陈江

Changes in sagittal parameters of cervical spine after single-level Mobi-C artificial disc replacement and ROI-C anterior cervical fusion

Ran Yu, Bai Chunxiao, Liu Chuyin, Zhao Xueqian, Long Shuiwen, Qin Changlong, Li Zhongze, Zhang Chao, Jia Yusong, Chen Jiang   

  1. Division 1, Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Received:2022-03-31 Accepted:2022-06-23 Online:2023-09-28 Published:2022-11-07
  • Contact: Chen Jiang, MD, Associate chief physician, Master’s supervisor, Division 1, Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • About author:Ran Yu, Master candidate, Division 1, Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Supported by:
    National Natural Science Foundation of China (Key Project), No. 81930116; National Natural Science Foundation of China (Youth Project), No. 81603638 (to CJ); China Postdoctoral Science Foundation, No. 222921 (to CJ); Beijing Dongcheng District Excellent Talents Training Funding Project (to CJ)

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摘要：


文题释义：

Mobi-C人工间盘：第二代非限制性人工颈椎间盘，由上下两端板及中间人工髓核构成，上下终板有横向排列的齿状结构，能保证假体植入后的稳定性，中间的人工髓核保留了瞬时旋转轴，能最大程度模拟正常椎间盘的生理运动功能。
ROI-C融合器：前路颈椎桥形锁定融合器。采用双嵌片技术自我锚定，将预弯桥型嵌片固定于上下椎体而实现椎体前缘零切迹，是传统钉板融合器的改进和升级。
颈椎矢状位参数：评价颈椎生物力学平衡的影像学参数，常用的有C2-7Cobb角、C2-7SVA和T1S。

背景：前期研究显示，双节段颈椎间盘置换对于颈椎矢状位参数有明显改善，且优于双节段ROI-C融合器，但不同手术节段的颈椎矢状位参数存在差异。
目的：研究单节段Mobi-C人工颈椎间盘置换与ROI-C颈椎前路融合术后颈椎矢状位参数的差异。
方法：回顾性分析2018年1月至2020年2月于北京中医药大学东直门医院就诊的60例神经根型、脊髓型或混合型颈椎病患者，按照手术方式分为Mobi-C间盘组和ROI-C融合组。所有患者均完成半年以上有效随访，平均随访时间为(12.1±5.0)个月，分别于术前、术后1周及末次随访时行目测类比评分、颈椎JOA评分以及拍摄X射线片，测量颈椎矢状位参数：C2-7Cobb角、C0-2Cobb角、C2-7矢状面轴向距离、颈椎斜率、T1倾斜角、C7倾斜角、胸廓入口角、脊柱功能单位角，分析两组患者的组内和组间差异，并行Pearson相关性分析。
结果与结论：①术后1周及末次随访时，两组患者目测类比评分均较术前明显降低(P < 0.05)、颈椎JOA评分显著增高(P < 0.05)。②与术前相比，术后1年的随访间盘组C2-7Cobb、C2-7矢状面轴向距离和T1倾斜角差异无显著意义(P > 0.05)，C0-2Cobb角、高T1倾斜角减小(P < 0.05)，脊柱功能单位角增大(P < 0.05)；融合组C2-7Cobb、C2-7矢状面轴向距离和T1倾斜角差异无显著意义(P > 0.05)，脊柱功能单位角和C7倾斜角增高(P < 0.05)；间盘组比融合组脊柱功能单位角增高(P < 0.05)。③患者术后矢状位参数，融合组 C2-7Cobb与C7倾斜角呈显著正相关；颈椎斜率与胸廓入口角呈显著正相关；T1倾斜角与C7倾斜角呈显著正相关；C7倾斜角与C0-2Cobb角呈显著负相关。置换组 C2-7Cobb与C7倾斜角、脊柱功能单位角和T1倾斜角呈显著正相关，与C0-2Cobb角呈显著负相关；颈椎斜率与胸廓入口角呈显著正相关，与C2-7矢状面轴向距离、T1倾斜角和脊柱功能单位角呈显著负相关；C2-7矢状面轴向距离与C7倾斜角、脊柱功能单位角、T1倾斜角呈显著正相关；T1S与C7倾斜角、脊柱功能单位角呈显著正相关，C7倾斜角与脊柱功能单位角呈显著正相关。④间盘组中，高T1倾斜角型患者术后胸廓入口角、T1倾斜角和C0-2Cobb角较术前明显降低(P < 0.05)，而脊柱功能单位角较术前明显增高(P < 0.05)；而融合组未发现显著变化。⑤结论：Mobi-C间盘和ROI-C融合器治疗单节段颈椎病疗效显著，与ROI-C融合器相比，Mobi-C间盘主要通过重建颈椎局部前凸角和上颈椎前凸角来恢复生理曲度，并且在高T1倾斜角患者群体中仍然保持这种能力。
https://orcid.org/0000-0001-5753-3674 (冉宇)；https://orcid.org/0000-0001-8539-6769  (陈江) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 单节段颈椎病, Mobi-C人工间盘, ROI-C融合器, 颈椎矢状位参数

Abstract: BACKGROUND: Preliminary studies have shown that double-level cervical disc replacement can significantly improve the sagittal parameters of the cervical spine, and is superior to the double-level ROI-C fusion cage, but there are differences in the sagittal parameters of the cervical spine in different surgical segments.  
OBJECTIVE: To study the differences between single-level Mobi-C artificial cervical disc replacement and sagittal parameters of the cervical spine after ROI-C anterior cervical fusion.
METHODS: Sixty patients with radicular, spinal cord or mixed cervical spondylosis who were treated in Dongzhimen Hospital, Beijing University of Chinese Medicine from January 2018 to February 2020 were retrospectively analyzed and divided into Mobi-C cervical artificial disc replacement group (disc group) and ROI-C anterior cervical fusion group (fusion group) according to the surgical method. All patients completed effective follow-up for more than half a year, mean (12.1±5.0) months. Visual analogue scale scores, cervical spine JOA scores, and X-ray films were detected before and 1 week after surgery and during final follow-up. The following cervical sagittal parameters were measured: C2-7 Cobb angle, C0-2 Cobb angle, C2-7 sagittal vertical axis, neck tilt, T1 slope, C7 slope, thoracic inlet angle, and spinal function unit angle. Intra- and intergroup differences were analyzed between both groups. A Pearson correlation analysis was conducted.  
RESULTS AND CONCLUSION: (1) At the 1 week after surgery and the last follow-up, visual analogue scale scores were significantly lower than before surgery (P < 0.05). Cervical spine JOA score was significantly higher (P < 0.05). (2) Compared with the preoperative data, there were no significant differences in C2-7 Cobb angle, C2-7 sagittal vertical axis or T1 slope in intervertebral disc group (P > 0.05); C0-2 Cobb angle and high T1 slope decreased (P < 0.05), while spinal function unit angle increased (P < 0.05). There were no significant differences in C2-7 Cobb angle, C2-7 sagittal vertical axis or T1 slope in the fusion group (P > 0.05), but spinal function unit angle and C7 slope increased (P < 0.05). Spinal function unit angle of the disc group was higher than that of the fusion group (P < 0.05). (3) The postoperative sagittal parameters of the patients in the fusion group showed a significant positive correlation between C2-7 Cobb angle and C7 slope; neck tilt was significantly positively correlated with thoracic inlet angle; T1 slope was significantly positively correlated with C7 slope; C7 slope was significantly positively correlated with C0-2 Cobb angle. In replacement group, C2-7 Cobb angle was significantly positively correlated with C7 slope, spinal function unit angle and T1 slope, and significantly negatively correlated with C0-2 Cobb angle; neck tilt was significantly positively correlated with thoracic inlet angle, and negatively correlated with C2-7 sagittal vertical axis, T1 slope and spinal function unit angle; C2-7 sagittal vertical axis was significantly positively correlated with C7 slope, spinal function unit angle and T1 slope; T1 slope was significantly positively correlated with C7 slope and spinal function unit angle; C7 slope was significantly positively correlated with spinal function unit angle. (4) In the disc group, postoperative thoracic inlet angle, T1 slope and C0-2 Cobb angle of patients with high T1 slope were significantly lower than those before operation (P < 0.05), while the spinal function unit angle was significantly higher than that before operation (P < 0.05). However, no significant changes were found in the fusion group. (5) It is concluded that Mobi-C intervertebral disc and ROI-C fusion device have significant efficacy in the treatment of single-level cervical spondylosis. Compared with the ROI-C cage, the Mobi-C disc restores the physiological curvature mainly by reconstructing the local cervical lordosis and upper cervical lordosis, and still maintains this ability in the high T1 slope angle patient population.

Key words: single-level cervical spondylosis, Mobi-C cervical disc, ROI-C fusion, cervical sagittal parameter

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