中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (11): 1665-1670.doi: 10.3969/j.issn.2095-4344.0160

• 人工假体 artificial prosthesis • 上一篇    下一篇

人工间盘尺寸大小对颈椎人工间盘置换效果的影响

宋卿鹏，田 伟，何 达，韩 骁，王晋超，李祖昌，冯 啸   

  1. 北京积水潭医院脊柱外科，北京大学第四临床医学院，北京市 100035
  • 出版日期:2018-04-18 发布日期:2018-04-18
  • 通讯作者: 田伟，教授，博士生导师，主任医师，北京积水潭医院脊柱外科，北京大学第四临床医学院，北京市 100035
  • 作者简介:宋卿鹏，男，1991年生，宁夏回族自治区银川市人，汉族，北京大学医学部在读博士，医师，主要从事脊柱外科的研究。
  • 基金资助:

    北京市卫生局科研基金资助项目(QML20160402)；北京市科学技术委员会专项经费资助项目(Z161100000516134)

Influence of the artificial disc size on cervical artificial disc replacement

Song Qing-peng, Tian Wei, He Da, Han Xiao, Wang Jin-chao, Li Zu-chang, Feng Xiao   

  1. Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing 100035, China
  • Online:2018-04-18 Published:2018-04-18
  • Contact: Tian Wei, Professor, Doctoral supervisor, Chief physician, Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing 100035, China
  • About author:Song Qing-peng, Doctoral candidate, Physician, Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing 100035, China
  • Supported by:

    the Scientific Research Program of Health Bureau of Beijing City, No. QML20160402; the Special Funding Project of the Beijing Municipal Science and Technology Committee, No. Z161100000516134

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摘要：

文章快速阅读：

 
 

 

文题释义：
颈椎人工间盘置换：为近年来应用于临床的颈椎非融合技术，其具有保留手术节段生理功能，在维持运动节段生物力学环境稳定的同时提供脊柱所需的稳定性，是最具有发展前景的脊柱生物力学重建技术。大量中长期随访研究表明颈椎人工间盘置换具有较好的临床疗效，然而远期随访中也存在手术节段活动度下降及丧失的情况，关于颈椎人工间盘置换后手术节段活动度是否能保持术前水平仍存在争议，文章中人工间盘与椎体终板≥95%组术后远期手术节段活动度保持良好。
人工间盘尺寸：目前临床常用的人工间盘尺寸均为固定型号且主要针对欧美人种设计，由于不同人种及不同节段间椎体终板大小并不一致，导致置入不同尺寸的人工间盘其终板覆盖比也并不一致，近年来有研究指出不同的人工间盘终板覆盖比可能会对疗效产生影响。Bryan间盘是最早广泛应用的人工间盘假体，其尺寸按端板直径大小分为14，15，16，17，18 mm 5种型号。
 
摘要
背景：人工间盘尺寸与椎体终板大小并不完全一致，而目前关于人工间盘大小对人工间盘置换效果的影响还未明确。
目的：探讨Bryan间盘大小对颈椎人工间盘置换效果的影响。
方法：纳入2003年12月至2007年12月因颈椎退行性疾病行单节段Bryan人工间盘置换的患者71例，平均年龄(45.90±8.12)岁，均随访10年以上。在X射线侧位片上测量人工间盘大小，人工间盘大小=(Bryan人工间盘端板矢状径×2)/(置换节段上终板矢状径+置换节段下终板矢状径) ×100%。分别于术前、术后3个月及末次随访时拍摄X射线片，测量置换节段活动度。并于术前、术后评估临床疗效，包括JOA评分、颈椎功能障碍指数和Odom’s评分。并对不同人工间盘大小(≥95%及<95%组)患者的观察指标进行统计对比分析。
结果与结论：①人工间盘大小比例≥95%组49例，人工间盘大小比例<95%组22例；②术后3个月随访时，人工间盘大小<95%组置换节段活动度显著小于≥95%组(P < 0.01)；末次随访时，人工间盘大小<95%组置换节段活动度小于≥95%组(P < 0.05)；③末次随访时，人工间盘大小<95%组JOA评分改善率为(70.65±32.58)%；人工间盘大小≥95%组JOA评分改善率为(68.83±38.85)%，2组间差异无显著性意义   (P > 0.05)；④末次随访时，人工间盘大小<95%组NDI减低(10.82±7.50)%；人工间盘大小≥95%组末次随访时NDI减低(12.61±8.51)%，2组间差异无显著性意义(P > 0.05)；⑤末次随访时，人工间盘大小<95%组Odem’s评分优10例(45%)，良9例(41%)，可3例(14%)；人工间盘大小≥95%组Odem’s评分优26例(53%)，良20例(41%)，可3例(6%)，2组间差异无显著性意义(P > 0.05)；⑥结果表明，2组不同大小的颈椎人工间盘置换后均获得了良好的功能恢复，但人工间盘过小会对置换节段活动度产生影响，应尽量避免置入的人工间盘与终板比例<95%。

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
ORCID: 0000-0002-2146-6913(宋卿鹏)

关键词: 颈椎人工间盘置换, 人工间盘大小, 长期随访, 骨科植入物, 脊柱植入物

Abstract:

BACKGROUND: The size of artificial disc is not exactly identical to cervical vertebral endplate. However, the effect of implant size on cervical disc replacement has not yet been clearly identified.

OBJECTIVE: To evaluate the effect of Bryan disc size on cervical artificial disc replacement.
METHODS: Totally 71 patients with cervical degenerative disease underwent single-level Bryan disc replacement from December 2003 to December 2007 were enrolled. The average age was (45.90±8.12) years old, and all patients were followed up for more than 10 years. The artificial disc size was measured using lateral X-ray films, and expressed as (Bryan artificial disc’s footprint sagittal diameter×2) / (upper endplate sagittal diameter + lower endplate’s sagittal diameter)×100%. X-ray films were photographed to measure motion range of the treated segment before surgery, 3 months after surgery, and during final follow-up. Clinical outcomes, including Japanese Orthopaedic Association score, Neck Disability Index and Odom’s scores, were evaluated before and after operation. Observational indexes of different disc sizes (≥95% and <95% groups) were compared and analyzed.
RESULTS AND CONCLUSION: (1) There were 49 patients in the ≥95% group and 22 patients in the <95% group. (2) At 3-month follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.01). At the final follow-up, range of motion was significantly smaller in the <95% group than in the ≥95% group (P < 0.05). (3) At final follow-up, improvement rate of Japanese Orthopaedic Association score was (70.65±32.58)% in the <95% group and (68.83±38.85)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (4) At final follow-up, Neck Disability Index decreased by (10.82±7.50)% in the <95% group, and (12.61±8.51)% in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (5) At final follow-up, Odem’s score results showed excellent in 10 cases (45%), good in 9 cases (41%) and average in 3 cases (14%) in the <95% group; and excellent in 26 cases (53%), good in 20 cases (41%) and average in 3 cases (6%) in the ≥95% group, and no significant difference was detected between the two groups (P > 0.05). (6) Results suggest that different sizes of artificial disc replacement have obtained good functional recovery, but small artificial disc may impact the range of motion. We should try to avoid placing the artificial disc smaller than 95%.

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

Key words: Cervical Vertebrae, Follow-Up Studies, Tissue Engineering

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