劉雅普 1,2 , 夏虹 2 , 艾福志 2 , 石林 2 , 隋文淵 2
  • 1 南方醫(yī)科大學研究生院（廣州，510515）;;
  • 2 廣州軍區(qū)廣州總醫(yī)院骨科醫(yī)院;

目的 研究人工頸椎間盤置換術治療頸椎病的臨床療效及鄰近節(jié)段退變情況。 方法 2008 年1 月－
2010 年10 月，采用人工頸椎間盤置換術治療頸椎病患者39 例。其中男20 例，女19 例；年齡32 ～ 60 歲，平均45.7 歲。
病程1 個月～ 10 年，平均30 個月。其中脊髓型頸椎病26 例，神經(jīng)根型頸椎病11 例，混合型頸椎病2 例（神經(jīng)根型加脊
髓型）。單節(jié)段病變27 例，雙節(jié)段病變12 例。使用Prestige 假體9 例、Prodisc-C 假體4 例、Discover 假體26 例。采用日
本骨科協(xié)會（JOA）評分評價患者神經(jīng)功能恢復情況，測量置換節(jié)段及鄰近節(jié)段活動度（Cobb 角變化），并采用Kellgren X
線頸椎退變分級評估法對鄰近節(jié)段頸椎間盤退變情況進行評價。 結果 所有患者均順利完成手術，術后切口均Ⅰ期愈
合。39 例均獲隨訪，隨訪時間12 ～ 36 個月，平均23.1 個月。末次隨訪時患者JOA 評分較術前顯著提高（P  lt; 0.05），置換
節(jié)段及置換節(jié)段相鄰上、下位節(jié)段活動度與術前比較差異均無統(tǒng)計學意義（P  gt; 0.05）。根據(jù)Kellgren X 線椎間盤退變分
級評價結果顯示，末次隨訪時有5 例患者出現(xiàn)退變情況改變，其中從無（0 級）退變?yōu)檩p度（1、2 級）3 例，由輕度1 級退變
到輕度2 級1 例，由輕度2 級退變到中度（3 級）1 例，退變發(fā)生率為12.8%，但退變情況分級與術前比較差異無統(tǒng)計學意
義（χ2=1.793，P=0.406）。術后15 個月（32 例患者）鄰近椎間盤未發(fā)生退變情況。 結論 人工頸椎間盤置換術治療頸椎
病有良好療效，可較好地保留置換節(jié)段及鄰近節(jié)段活動度，并可能對鄰近節(jié)段的椎間盤起保護作用。

引用本文： 劉雅普,夏虹,艾福志,石林,隋文淵. 人工頸椎間盤置換術后鄰近節(jié)段退變情況的早中期隨訪. 中國修復重建外科雜志, 2012, 26(4): 385-389. doi: 復制

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1. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
2. 安春厚, 郭金明, 原泉. 頸椎椎間融合術后鄰近節(jié)段病變的臨床觀察. 中國修復重建外科雜志, 2008, 22(4): 390-393.
3. Kulkarni V, Rajshekhar V, Raghuram L. Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurgery, 2004, 100(1 Suppl Spine): 2-6.
4. Jawahar A, Cavanauqh DA, Kerr EJ 3rd, et al. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12): 1043-1048.
5. 孫宇, 趙衍斌, 周非非, 等. 頸椎人工椎間盤置換后對相鄰節(jié)段退變的影響. 中國脊柱脊髓雜志, 2011, 21(6): 474-479.
6. Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. vol II: Atlas of standard radiographs of arthritis. Oxford: Blackwell Scientific Publications, 1963: 14-19.
7. Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan cervical disc prosthesis. Neurosurgery, 2002, 51(3): 840-847.
8. 韓慧, 董榮華, 曹富江. Bryan人工頸椎間盤置換近期療效分析. 中國矯形外科雜志, 2009, 17(15): 1152-1154.
9. 劉國輝, 張鵬, 楊述華, 等. Bryan人工頸椎間盤置換治療頸椎間盤突出癥. 臨床骨科雜志, 2008, 11(2): 104-106.
10. Kim SW, Paik SH, Castro PA, et al. Analysis of factors that may influence range of motion after cervical disc arthroplasty. Spine J, 2010, 10(8): 683-688.
11. Galbusera F, Bellini CM, Raimondi MT, et al. Cervical spine biomechanics following implantation of a disc prosthesis. Med Eng Phys, 2008, 30(9): 1127-1133.
12. Pimenta L, McAfee PC, Cappuccino A, et al. Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J, 2004, 4(6 Suppl): 315S-321S.
13. Yi S, Lim JH, Choi KS, et al. Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy. Surg Neurol, 2009, 71(6): 677-680.
14. Peng CW, Quirno M, Bendo JA, et al. Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement. Spine J, 2009, 9(7): 551-555.
15. Kyeong-Sik Ryu, Han-Yong Heo, Sung-Jae Lee, et al. Prognostic factors related to motion dynamics following cervical arthroplasty with a Bryan disc: average 2-year follow-up. SAS Journal, 2008, 2(2): 86-91.
16. Kang KC, Lee CS, Han JH, et al. The factors that influence the postoperative segmental range of motion after cervical artificial disc replacement. Spine J, 2010, 10(8): 689-696.
17. 蔣濤, 任先軍, 王衛(wèi)東, 等. 人工頸椎間盤置換對鄰近節(jié)段椎間盤的保護作用. 中國矯形外科雜志, 2010, 18(7): 529-533.
18. Jawahar A, Cavanaugh DA, Kerr III 3rd, et al. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12): 1043-1048.
19. 韓珂. 人工頸椎間盤置換的三維有限元法生物力學研究. 湖南: 中南大學, 2011.
20. McAfee P, Pimenta L, Cappuccino A, et al. Survivorship analysis of multilevel cervical disc replacement—a prospective series of 228 prosthetic implantations. Spine J, 2006, 6(5): S88-89.
21. 金大地. 頸椎融合與人工頸椎間盤置換術存在的問題. 中國脊柱脊髓雜志, 2008, 18(1): 9-10.
22. Fekete TF, Porchet F. Overview of disc arthroplasty—past, present and future. Acta Neurochir (Wien), 2010, 152(3): 393-404.
  1. 1. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J, 2009, 18(2): 218-231.
  2. 2. 安春厚, 郭金明, 原泉. 頸椎椎間融合術后鄰近節(jié)段病變的臨床觀察. 中國修復重建外科雜志, 2008, 22(4): 390-393.
  3. 3. Kulkarni V, Rajshekhar V, Raghuram L. Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurgery, 2004, 100(1 Suppl Spine): 2-6.
  4. 4. Jawahar A, Cavanauqh DA, Kerr EJ 3rd, et al. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12): 1043-1048.
  5. 5. 孫宇, 趙衍斌, 周非非, 等. 頸椎人工椎間盤置換后對相鄰節(jié)段退變的影響. 中國脊柱脊髓雜志, 2011, 21(6): 474-479.
  6. 6. Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. vol II: Atlas of standard radiographs of arthritis. Oxford: Blackwell Scientific Publications, 1963: 14-19.
  7. 7. Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan cervical disc prosthesis. Neurosurgery, 2002, 51(3): 840-847.
  8. 8. 韓慧, 董榮華, 曹富江. Bryan人工頸椎間盤置換近期療效分析. 中國矯形外科雜志, 2009, 17(15): 1152-1154.
  9. 9. 劉國輝, 張鵬, 楊述華, 等. Bryan人工頸椎間盤置換治療頸椎間盤突出癥. 臨床骨科雜志, 2008, 11(2): 104-106.
  10. 10. Kim SW, Paik SH, Castro PA, et al. Analysis of factors that may influence range of motion after cervical disc arthroplasty. Spine J, 2010, 10(8): 683-688.
  11. 11. Galbusera F, Bellini CM, Raimondi MT, et al. Cervical spine biomechanics following implantation of a disc prosthesis. Med Eng Phys, 2008, 30(9): 1127-1133.
  12. 12. Pimenta L, McAfee PC, Cappuccino A, et al. Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J, 2004, 4(6 Suppl): 315S-321S.
  13. 13. Yi S, Lim JH, Choi KS, et al. Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy. Surg Neurol, 2009, 71(6): 677-680.
  14. 14. Peng CW, Quirno M, Bendo JA, et al. Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement. Spine J, 2009, 9(7): 551-555.
  15. 15. Kyeong-Sik Ryu, Han-Yong Heo, Sung-Jae Lee, et al. Prognostic factors related to motion dynamics following cervical arthroplasty with a Bryan disc: average 2-year follow-up. SAS Journal, 2008, 2(2): 86-91.
  16. 16. Kang KC, Lee CS, Han JH, et al. The factors that influence the postoperative segmental range of motion after cervical artificial disc replacement. Spine J, 2010, 10(8): 689-696.
  17. 17. 蔣濤, 任先軍, 王衛(wèi)東, 等. 人工頸椎間盤置換對鄰近節(jié)段椎間盤的保護作用. 中國矯形外科雜志, 2010, 18(7): 529-533.
  18. 18. Jawahar A, Cavanaugh DA, Kerr III 3rd, et al. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J, 2010, 10(12): 1043-1048.
  19. 19. 韓珂. 人工頸椎間盤置換的三維有限元法生物力學研究. 湖南: 中南大學, 2011.
  20. 20. McAfee P, Pimenta L, Cappuccino A, et al. Survivorship analysis of multilevel cervical disc replacement—a prospective series of 228 prosthetic implantations. Spine J, 2006, 6(5): S88-89.
  21. 21. 金大地. 頸椎融合與人工頸椎間盤置換術存在的問題. 中國脊柱脊髓雜志, 2008, 18(1): 9-10.
  22. 22. Fekete TF, Porchet F. Overview of disc arthroplasty—past, present and future. Acta Neurochir (Wien), 2010, 152(3): 393-404.