中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3046-3049.doi: 10.3969/j.issn.1673-8225.2010.17.002

• 人工假体 artificial prosthesis • 上一篇    下一篇

人工颈椎间盘置换早期运动学分析：55例资料验证

卢中道1，翟明玉1，杨  勇1，刘海鹰2   

  1. 1郑州市骨科医院，河南省郑州市 450052；2北京大学人民医院，北京市 100044
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 作者简介:卢中道★，男，1967年生，河南省偃师市人，汉族，2004年郑州大学医学院毕业，硕士，副主任医师，主要从事脊柱外科研究。 lzdmike3251@yahoo.com.cn

Cervical kinematics following cervical intervertebral disc replacement: Validation of 55-case data

Lu Zhong-dao1, Zhai Ming-yu1, Yang Yong1, Liu Hai-ying2   

  1. 1 Zhengzhou Orthopedics Hospital, Zhengzhou   450052, Henan Province, China; 2 Peking University People’s Hospital, Beijing   100044, China
  • Online:2010-04-23 Published:2010-04-23
  • About author:Lu Zhong-dao★, Master, Associate chief physician, Zhengzhou Orthopedics Hospital, Zhengzhou 450052, Henan Province, China lzdmike3251@yahoo.com.cn

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摘要：

背景：颈椎前路椎间盘切除椎间融合被认为是治疗颈椎病的金标准，但是融合后产生临近节段的加速退变。采用人工颈椎间盘置换治疗颈椎病和颈椎间盘突出症在解除患者脊髓压迫的同时保持了颈椎的活动度和稳定性，恢复椎间盘正常的生物力学特点，防止邻近椎间盘的加速退变。
目的：观察颈椎Prodisc人工颈椎椎间盘置换的临床应用效果及术后的运动学变化。
方法：选择55例69个椎间盘,其中双节段受损14例；男29例,女26例,年龄48(31~76)岁；脊髓型颈椎病32例,神经根型颈椎病9例,混合型颈椎病14例。取颈椎前横切口或斜切口入路行Prodisc人工颈椎间盘置换。于置换前、置换后3，6，12，24个月观察颈椎正侧位、过伸过屈、左右侧屈位片，JOA评分分析置换前后椎间盘功能改善情况。
结果与结论：随访55例69个椎间盘, 41例行单节段人工颈椎间盘置换, 14例行双节段人工颈椎椎间盘置换。置换后随22(56~48)个月。 置换后JOA评分显示椎体功能改善率达56%。置换后手术节段椎间盘矢状面、冠状面活动度与置换前比较差异无显著性意义(P = 0.45，0.74)，并保持了和邻近间隙同样的活动度和稳定性。说明颈椎人工椎间盘置换后保留了原来的椎间盘的活动度，患者恢复快，对邻近椎间盘的影响小。

关键词: 颈椎病, 人工颈椎间盘, 置换, 医学植入体, 数字化骨科

Abstract:

BACKGROUND: Anterior cervical discectomy and fusion has been considered the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion may result in progressive degeneration of the adjacent segments. Artificial disc replacement seems to be promising, segmental motion and stability are preserved while the spinal canal has been enlarged, and the intervertebral disc biological mechanics has been preserved, but not leads to progressive degeneration of the adjacent segments.
OBJECTIVE: To observe the functional outcome and kinematics after the Prodisc artificial neck intervertebral disc replacement.
METHODS: A total of 55 cases (69 intervertebral discs), 29 males and 26 females, aged 48 (31-76) years were selected, including 14 with bi-segmental injury. There were 32 cases of cervical spondylotic myelopathy, 9 of cervical spondylotic radiculopathy, and 14 of mixed type cervical spondylosis. Prodisc artificial neck intervertebral disc replacement was performed using anterior or oblique incision. Prospective data JOA score and kinematic measures were collected before surgery and at 3, 6, 12, and 24 months after surgery. Range of motion was determined by independent radiologic assessment of flexion-extension radiographs.
RESULTS AND CONCLUSION: The 55 patients were followed-up, including 41 undergoing single segmental disc replacement and 14 undergoing bi-segmental disc replacement. They were followed up for 22 (56-48) months postoperatively. JOA scores displayed improved cervical function by 56%. Range of motion of sagittal and coronal planes were similar to those prior to operation compared with preoperatively (P = 0.45, 0.74), and the range of motion and stability were maintained as adjacent segments. Results showed that the artificial disc replacement maintained range of motion of original intervertebral disc, accelerated patient recovery, and slightly affected adjacent intervertebral disc.

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