摘要
目的观察颈椎动态稳定器（dynamic cervical implant，DCI）治疗颈椎病术后颈椎曲度和活动度的变化情况，探讨其应用的安全性及有效性。方法2009年8月至2012年1月，收治符合DCI植入指征的颈椎病患者17例，其中男7例，女10例；年龄36～53岁，平均43．4岁。脊髓型颈椎病4例，神经根型颈椎病13例。病变节段：C3-4 1例，C4-5 6例，C5-6例，C6-7 4例。17例均行颈前路椎间盘切除、椎管减压后DcI植入术。测量术前和末次随访时DCI植入节段及相邻节段的活动度（range of motion，ROM）、DCI植入节段脊柱功能单位（functional spinal unit，FSU）Cobb’s角和颈椎整体曲度（C2-7Cobb’s角）。采用Miyazaki颈椎间盘退变分级方法评定相邻节段椎间盘退变情况。结果17例均随访12～41个月（平均19．4个月）。DCI植入节段术前ROM（7．8±2．2）°，末次随访（8．4±2．5）°，差异无统计学意义（P〉0．05）。上下相邻节段术前ROM（8.3±1．9）°、（8．7±2．1）°，末次随访（8．5±2．1）°、（8．8±2．4）°，差异无统计学意义（P〉0．05）。DCI植入节段FSUCobb’s角术前（0．4±5．1）°，末次随访（3．7±5．5）°，差异有统计学意义（P〈0．05）。颈椎整体曲度术前（7．8±11．2）°，末次随访（8．6±10．7）°，差异无统计学意义（P〉0．05）。MRI随访发现34个相邻节段中3个f9％）椎间盘退变分级加重1级，但无相关临床症状出现。结论应用颈椎动态稳定器治疗单节段颈椎病，可以有效改善FSU后凸，恢复颈椎局部前凸，并能较好的保留手术节段、相邻节段及整个颈椎的运动学特性，理论上有利于预防相邻椎间盘的退变，但仍然需要更长期的随访来进一步评估。
Objective To observe the changes of the cervical alignment and range of motion （ ROM ） after single-level dynamic cervical implant （ DCI ） implantation for patients with cervical spondylosis, and to evaluate its safety and efficiency. Methods From August 2009 to January 2012, 17 patients with cervical spondylosis were received and treated according to the indications of DCI implantation, including 4 cases of cervical spondylotic myelopathy and 13 cases of cervical spondylotic radiculopathy. There were 7 males and 10 females, with a mean age of 43.4 years old （ range; 36-53 years ）. The affected segments included C3-4 in 1 case, C4-5 in 6 cases, C5-6 in 6 cases and C6-7 in 4 cases. Anterior cervical disceetomy and DCI implantation after spinal canal decompression were performed on 17 patients. The ROM of DCI implantation segments and adjacent segments preoperatively and in the latest follow-up was measured, as welt as the Cobb＇s angle of DCI implantation segments at fimctional spinal unit （ FSU ） and the overall cervical alignment Cobb＇s angle from C2-7. The adjacent segment degeneration was evaluated according to Miyazaki classification of cervical disc degeneration. Results All patients were followed up for a mean period of 19.4 months （ range; 12-41 months ）. The ROM of DCI implantation segments was （ 7.8±2.2 ）° preoperatively and （ 8.4±2.5 ） ° in the latest follow-up respectively, without statistically significant difference （ P〉0.05 ）. The ROM at adjacent segment level was （ 8.3±1.9 ） ° and （ 8.7±2.1 ） ° preoperatively and （ 8.5±2.1 ） ° and （ 8.8±2.4 ）° in the latest follow-up respectively, without statistically significant difference （ P〉0.05 ）. The Cobb＇s angle of DCI implantation segments at FSU was （ 0.4±5.1 ） ± preoperatively and （ 3.7±5.5 ） ° in the latest follow-up respectively, with statistically significantdifferences （ P〈0.05 ）. The overall cervical alignment Cobb＇s angle was （ 7.8±11.2 ） ° preoperatively and （ 8.6± 10.7 ） ° in the latest follow-up respectively, without statistically significant difference （ P〉0.05 ）. All patients gained MRI follow-up. Disc degeneration up to 1 grade occurred to 3 of 34 （ 9% ） adjacent segments, and no relative clinical symptom appeared. Conclusions DCI in the treatment of single-level cervical spondylosis can effectively improve FSU kyphosis and recover cervical local lordosis, as well as preserve the kinematics characteristics of operation segments, adjacent segments and the whole cervical spine. Theoretically, DCI is conducive to the prevention of adjacent intervertebral disc degeneration, which still should be further assessed after a long-term follow-up.
出处
《中国骨与关节杂志》
CAS
2013年第10期574-579,共6页
Chinese Journal of Bone and Joint
关键词
颈椎病
随访研究
椎间盘退行性变
脊柱融合术
矫形外科手术
Cervical spondylosis
Follow-up studies
Intervertebral disc degeneration
Spinal fusion
Orthopedic procedures
