单节段Bryan颈椎间盘置换远期屈伸旋转中心变化△

Long-term variation of flexion-extension center of rotation secondary to single-segment Bryan cervical disc replacement

摘要:

［目的］ 观察单节段 Bryan 人工颈椎间盘置换术 （artificial cervical disc replacement, ACDR） 远期随访的运动学结果。 ［方法］ 回顾性分析 2010 年 1 月—2013 年 3 月于本院行单节段 Bryan ACDR 且末次随访手术节段活动度 （range of motion, ROM） >5°的 38 例患者的临床资料。观察临床与影像结果。［结果］ 38 例患者均顺利完成手术，无严重并发症。随访 84~118 个月，平均 （93.97±9.67） 个月。末次随访时，患者颈椎病相关症状明显改善，JOA 评分较术前明显升高 （P<0.05），NDI 评分、颈痛及上肢痛 VAS 评分较术前显著降低（P<0.05）。至末次随访期时，所有患者均未出现症状加剧，无再次入院，无翻修手术。影像方面，与术前相比，末次随访时颈椎整体曲度和手术节段曲度均显著增加（P<0.05），而颈椎整体 ROM、手术节段 ROM、上邻节段 ROM 和下邻节段 ROM，以及 COR-X 和 COR-Y 均无显著改变（P>0.05）。相关分析表明，末次随访时 COR-Y 与手术节段 ROM 呈显著负相关（P<0.05），与手术节段平移距离呈显著负相关（P<0.05）；此外，手术节段 ROM 与同节段平移距离呈正相关（r=0.772，P<0.05）。COR-Y 与其他临床和影像指标均无明显相关性（P>0.05），而 COR-X 与任何指标均无相关性（P>0.05）。［结论］单节段 Bryan ACDR 7 年以上随访临床疗效与影像结果满意。末次随访时手术节段 COR-Y 与平移、ROM 的关系与正常颈椎节段类似，这有助于模拟颈椎生理运动模式。

Abstract:

[Objective] To observe the long-term kinematic consequences, especially variation of the center of rotation (COR) of the in- volved segment, of single-segment Bryan cervical disc replacement (CDR) . [Methods] A retrospective study was conducted on 38 patients who received single-segment Bryan CDR in our hospital from January 2010 to March 2013, and had range of motion (ROM) at the affected segment ＞ 5° at the latest follow-up. Clinical and radiographic documents were analyzed. [Results] All the 38 patients had operation per- formed successfully without serious complications. The follow-up period lasted for 84 to 118 months, with a mean of (93.97±9.67) months. The symptoms related to cervical spondylosis were significantly improved at the latest follow-up. The JOA score significantly increased (P＜ 0.05) , whereas the NDI score and VAS scores for neck pain and upper limb pain significantly decreased postoperatively compared with those preoperatively (P＜0.05) . By the time of latest follow-up, no exacerbation of symptoms, readmission, or revision surgery had occurred in anyone of the patients. Radiographically, overall cervical curvature and involved segmental curvature significantly increased (P＜0.05) , whereas the overall ROM, involved segmental ROM, upper adjacent ROM and lower adjacent ROM, COR-X and COR-Y remained un- changed at the latest follow-up compared with those before operation (P＞0.05) . As correlation analysis, the COR-Y was significantly nega- tively correlated with the ROM (P＜0.05) , and the translational distance of the involved segment at the latest follow-up (P＜0.05) . In addi- tion, the ROM was significantly positively correlated with translational distance of the same segment (r=0.772, P＜0.05) . The COR-Y had no significant correlation with other clinical and imaging items (P＞0.05) , while COR-X had no correlation with any parameters (P＞0.05) . [Conclusion] The clinical and radiographic results of single-segment Bryan CDR do still be satisfactory more than 7 years after operation. The relationships between COR-Y, translational displacement and ROM of the involved segment at the last follow-up is similar to that of normal cervical segment, which is conductive to remaining motion in physiologic manner.