中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (15): 2341-2346.doi: 10.3969/j.issn.2095-4344.3799

• 人工假体 artificial prosthesis • 上一篇    下一篇

双节段颈人工椎间盘置换与颈椎间盘切除融合后颈椎矢状位参数的变化

陈  江1，2，李晋玉1，郑晨颖1，白春晓1，张  帆1，刘楚吟1，赵学千1，袁巧妹1，邸学士1，康晟乾1，贾育松1   

  1. 1北京中医药大学东直门医院骨伤科，北京市   100700；2湖南中医药大学，湖南省长沙市   410208
  • 收稿日期:2020-07-28 修回日期:2020-07-29 接受日期:2020-09-01 出版日期:2021-05-28 发布日期:2021-01-04
  • 通讯作者: 贾育松，主任医师，教授，博士生导师，北京中医药大学东直门医院骨伤科，北京市 100700
  • 作者简介:陈江，男，1983年生，湖北省宜昌市人，汉族，2011年北京中医药大学毕业，博士，副主任医师，硕士生导师，主要从事脊柱外科、椎间盘退变及细胞生物力学研究。
  • 基金资助:
    国家自然科学基金项目(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；北京中医药大学2018年度基本科研业务费项目(2018-JYB-XJQ010)，项目负责人：陈江；北京中医药大学东直门医院青苗人才项目(DZMYS-201702)，项目负责人：陈江

Changes in sagittal parameters of cervical spine after double-segment artificial cervical disc replacement and anterior cervical discectomy and fusion

Chen Jiang1, 2, Li Jinyu1, Zheng Chenying1, Bai Chunxiao1, Zhang Fan1, Liu Chuyin1, Zhao Xueqian1, Yuan Qiaomei1, Di Xueshi1, Kang Shengqian1, Jia Yusong1    

  1. 1Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; 2Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China 
  • Received:2020-07-28 Revised:2020-07-29 Accepted:2020-09-01 Online:2021-05-28 Published:2021-01-04
  • Contact: Jia Yusong, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • About author:Chen Jiang, MD, Associate chief physician, Master’s supervisor, Department of Orthopedics and Traumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81603638 (to CJ); the China Postdoctoral Science Foundation, No. 222921 (to CJ); the Basic Scientific Research Business Expenses of Beijing University of Chinese Medicine in 2018, No. 2018-JYB-XJQ010 (to CJ); the Young Talent Project of Dongzhimen Hospital of Beijing University of Chinese Medicine, No. DZMYS-201702 (to CJ) 

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摘要：

文题释义：
颈椎人工间盘置换：通过颈椎前方入路切除退变的颈椎间盘替换为人工颈椎间盘，达到治疗颈椎病而不影响颈椎活动度的目的。
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-C7 Cobb角、C2-C7矢状位轴向距离和T1倾斜角。

背景：颈椎生物力学近年来成为研究的热点，探究不同手术方式对颈椎矢状位参数的影响可以更加优化术前手术方案设计，取得更好的临床疗效。
目的：探讨双节段颈人工椎间盘置换与颈椎间盘切除融合治疗对颈椎术后矢状位参数的影响。
方法：回顾性分析2014年10月至2018年12月北京中医药大学东直门医院收治的90例相邻两节段神经根型或脊髓型颈椎病患者的病历资料，其中45例接受双节段颈椎人工间盘置换治疗(置换组)，另45例接受双节段前路椎间盘切除融合治疗(融合组)。术前及术后末次随访时拍摄颈椎侧位X射线片，测量手术节段角度、C2-C7 Cobb角、C2-C7矢状位轴向距离和T1倾斜角等颈椎矢状位参数，对比手术前后差异与组间差异。同时，采用Pearson相关性分析手术前后影像学参数间的相关性。试验获得北京中医药大学东直门医院伦理委员会批准。
结果与结论：①置换组术后末次随访的手术节段角度、C2-C7 Cobb角、C2-C7矢状位轴向距离和T1倾斜角均较术前增加(P < 0.05)，融合组术后末次随访的上述指标与术前比较无明显变化(P > 0.05)；置换组术后末次随访的手术节段角度、C2-C7 Cobb角大于融合组(P < 0.05)；②术前，置换组的T1倾斜角与手术节段角度、C2-C7 Cobb角、C2-C7矢状位轴向距离呈正相关(P < 0.05)，C2-C7 Cobb角与手术节段角度呈正相关(P < 0.05)；术后末次随访时，T1倾斜角与手术节段角度、C2-C7 Cobb角呈正相关(P < 0.05)，手术节段角度与C2-C7 Cobb角呈正相关(P < 0.05)；③术前(或术后)，融合组的T1倾斜角与手术节段角度、C2-C7 Cobb角、C2-C7矢状位轴向距离呈正相关(P < 0.05)，C2-C7 Cobb角与手术节段角度呈正相关(P < 0.05)；④结果表明，与颈椎间盘切除融合治疗相比，双节段颈椎人工间盘置换治疗在恢复颈椎病患者置换节段角度及矢状位参数方面具有优势。
https://orcid.org/0000-0001-8539-6769 (陈江) ；0000-0002-3203-5182(贾育松) 

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: 骨, 植入物, 颈椎病, 人工间盘置换, 脊柱融合, 矢状位参数

Abstract: BACKGROUND: Cervical biomechanics has become a focus of research in recent years. Exploring the influence of different surgical methods on cervical sagittal position parameters can better optimize preoperative surgical plan design and achieve better clinical efficacy.   
OBJECTIVE: To investigate the effects of double-segment cervical total disc replacement and anterior cervical discectomy and fusion on sagittal parameters in the treatment of cervical spondylosis. 
METHODS: Ninety cases of cervical spondylosis of two adjacent segments of nerve root type or spinal cord type from October 2014 to December 2018 at Dongzhimen Hospital of Beijing University of Chinese Medicine were retrospectively analyzed. Of them, 45 cases received double-segment cervical total disc replacement (replacement group), and 45 cases received double-segment anterior cervical discectomy and fusion (fusion group). The sagittal parameters of the cervical vertebra at preoperation and the last follow-up were measured, including segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 slope. The difference between the two groups was compared before and after operation. Pearson correlation was used to analyze the correlation between imaging parameters before and after surgery. This trial was approved by the Ethics Committee of Dongzhimen Hospital of Beijing University of Chinese Medicine.  
RESULTS AND CONCLUSION: (1) The operative segment angle, C2-C7 Cobb angle, C2-C7 sagittal axial distance and T1 inclination angle in the final follow-up of the replacement group were all increased compared with those before the surgery (P < 0.05), and the above indicators in the final follow-up of the fusion group were not significantly changed compared with those before the surgery (P > 0.05). The operative segment angle and C2-C7 Cobb angle in the replacement group were higher than those in the fusion group (P < 0.05). (2) Before surgery, T1 inclination angle of the replacement group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle (P < 0.05). At the last follow-up, T1 inclination angle was positively correlated with segment angle and C2-C7 Cobb angle (P < 0.05), and segment angle was positively correlated with C2-C7 Cobb angle (P < 0.05). (3) Before (or after) surgery, T1 inclination angle of fusion group was positively correlated with segmental angle, C2-C7 Cobb angle and C2-C7 sagittal axial distance (P < 0.05), while C2-C7 Cobb angle was positively correlated with segmental angle of fusion group (P < 0.05). (4) The results showed that compared with cervical discectomy and fusion therapy, double-segment artificial intervertebral disc replacement therapy had advantages in restoring segmental angle and sagittal position parameters of cervical spondylopathy.

Key words: bone, implant, cervical spondylosis, artificial disc replacement, spinal fusion, sagittal parameters

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