• 1 桂林醫(yī)學(xué)院附屬醫(yī)院脊柱骨病外科（廣西桂林，541001）;;
  • 2 廣西醫(yī)科大學(xué)附屬第一醫(yī)院脊柱關(guān)節(jié)外科;

目的 探討頸椎間盤置換治療脊髓型頸椎病的療效。 方法2006年10月－2008年10月，采用椎間盤置換治療20例（26個(gè)節(jié)段）脊髓型頸椎病患者。男8例，女12例；年齡26～65歲，平均46歲。病程2～18個(gè)月，平均7個(gè)月。單節(jié)段置換14例，雙節(jié)段置換6例。術(shù)后以O(shè)dom等標(biāo)準(zhǔn)評(píng)價(jià)療效，以疼痛視覺模擬評(píng)分（VAS）評(píng)價(jià)頸、肩部及上肢疼痛情況。X線片測量假體椎間盤間隙角及頸椎過屈、過伸位活動(dòng)度，觀察異位骨化、骨贅形成及假體松動(dòng)等情況。 結(jié)果術(shù)后切口均Ⅰ期愈合，無嚴(yán)重并發(fā)癥發(fā)生。20 例均獲隨訪，隨訪時(shí)間30 ～ 48個(gè)月，平均34個(gè)月。術(shù)后28個(gè)月按Odom等標(biāo)準(zhǔn)獲優(yōu)17例、良3例，頸、肩部及上肢VAS評(píng)分均較術(shù)前顯著改善（P  lt; 0.05）。術(shù)后30個(gè)月，20個(gè)置換節(jié)段未融合，假體活動(dòng)度為（10.6 ± 4.5）°，與上位相鄰節(jié)段的（10.8 ± 3.7）°和下位相鄰節(jié)段的（7.5 ± 4.2）°比較差異均無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。術(shù)后10例13個(gè)節(jié)段發(fā)生異位骨化，1例假體后方移位；其他假體無移位、下沉、松動(dòng)等并發(fā)癥發(fā)生。 結(jié)論頸椎間盤置換治療脊髓型頸椎病能維持頸椎正常活動(dòng)范圍和生理彎曲，但其功能和對(duì)鄰近節(jié)段的影響需進(jìn)一步隨訪。

引用本文： 嚴(yán)冬雪,肖增明,沈翀,黃永吉. 頸椎間盤置換治療脊髓型頸椎病的療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(9): 1058-1061. doi: 復(fù)制

1. 劉忠軍. 脊柱外科手術(shù)操作與技巧. 北京: 人民衛(wèi)生出版社, 2009: 26.
2. Odom GL, Finney W, Woodhall B. Cervical disc lesions. J Am Med Assoc, 1958, 166(1): 23-28.
3. McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
4. 農(nóng)魯明, 周棟, 徐南偉, 等. 人工頸椎間盤置換術(shù)治療頸椎病的中期療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 567-571.
5. 郭隆升, 馬曉春, 付鵬, 等. Bryan人工椎間盤置換術(shù)治療頸椎病的初步探討. 中國現(xiàn)代醫(yī)學(xué), 2010, 48(8): 144-148.
6. Goffin J, van Loon J, van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow-up results after cervical disc replacement surgery using the Bryan cervical disc prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
7. Cheng L, Nie L, Zhang L, et al. Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomized study. Int Orthop, 2008, 33(5): 1037-1351.
8. 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.
9. Wenger M, van Hoonacker P, Zachee B, et al. Bryan cervical disc prosthesis: preservation of function over time. J Clin Neurosci, 2009, 16(2): 220-225.
10. 劉文華, 朱兵, 劉曉偉, 等. 單節(jié)段Bryan人工頸椎間盤置換術(shù)后異位骨化的發(fā)生率和療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(6): 699-702.
11. Leung C, Casey AT, Goffin J, et al. Clinical significance of heteroptopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery, 2005, 57(4): 759-763.
12. Mehran C, Suchomel P, Grochulla F, et al. Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976), 2006, 31(24): 2802-2806.
13. Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty: a prospective, randomized, controlled, single site trial with48-month follow-up. J Spinal Disord Tech, 2010, 23 (6): 367-371.
14. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty , 2009, 24(2): 256-262.
15. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
16. Wu SK, Kuo LC, Lan HC, et al. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur Spine J, 2007, 16(9): 1435-1444.
17. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am), 1999, 81(4): 519-528.
18. DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech, 2003, 16(4): 314-323.
19. Faizan A, Goel VK, Garfin SR, et al. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation. Eur Spine J, 2012, 21 Suppl 5: 653-662.
20. Zechmeister I, Winkler R, Mad P. Artificial total disc replacement versus fusion for the cervical spine: a systematic review. Eur Spine J, 2011, 20(2): 177-184.
21. 謝華, 徐南偉, 農(nóng)魯明, 等. Prodisc-C人工頸椎間盤置換術(shù)治療中老年頸椎病的療效. 江蘇醫(yī)學(xué), 2011, 37(6): 691-693.
  1. 1. 劉忠軍. 脊柱外科手術(shù)操作與技巧. 北京: 人民衛(wèi)生出版社, 2009: 26.
  2. 2. Odom GL, Finney W, Woodhall B. Cervical disc lesions. J Am Med Assoc, 1958, 166(1): 23-28.
  3. 3. McAfee PC, Cunningham BW, Devine J, et al. Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech, 2003, 16(4): 384-389.
  4. 4. 農(nóng)魯明, 周棟, 徐南偉, 等. 人工頸椎間盤置換術(shù)治療頸椎病的中期療效觀察. 中國脊柱脊髓雜志, 2010, 20(7): 567-571.
  5. 5. 郭隆升, 馬曉春, 付鵬, 等. Bryan人工椎間盤置換術(shù)治療頸椎病的初步探討. 中國現(xiàn)代醫(yī)學(xué), 2010, 48(8): 144-148.
  6. 6. Goffin J, van Loon J, van Calenbergh F, et al. A clinical analysis of 4- and 6-year follow-up results after cervical disc replacement surgery using the Bryan cervical disc prosthesis. J Neurosurg Spine, 2010, 12(3): 261-269.
  7. 7. Cheng L, Nie L, Zhang L, et al. Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomized study. Int Orthop, 2008, 33(5): 1037-1351.
  8. 8. 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.
  9. 9. Wenger M, van Hoonacker P, Zachee B, et al. Bryan cervical disc prosthesis: preservation of function over time. J Clin Neurosci, 2009, 16(2): 220-225.
  10. 10. 劉文華, 朱兵, 劉曉偉, 等. 單節(jié)段Bryan人工頸椎間盤置換術(shù)后異位骨化的發(fā)生率和療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(6): 699-702.
  11. 11. Leung C, Casey AT, Goffin J, et al. Clinical significance of heteroptopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery, 2005, 57(4): 759-763.
  12. 12. Mehran C, Suchomel P, Grochulla F, et al. Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976), 2006, 31(24): 2802-2806.
  13. 13. Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty: a prospective, randomized, controlled, single site trial with48-month follow-up. J Spinal Disord Tech, 2010, 23 (6): 367-371.
  14. 14. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty , 2009, 24(2): 256-262.
  15. 15. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
  16. 16. Wu SK, Kuo LC, Lan HC, et al. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur Spine J, 2007, 16(9): 1435-1444.
  17. 17. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am), 1999, 81(4): 519-528.
  18. 18. DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech, 2003, 16(4): 314-323.
  19. 19. Faizan A, Goel VK, Garfin SR, et al. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation. Eur Spine J, 2012, 21 Suppl 5: 653-662.
  20. 20. Zechmeister I, Winkler R, Mad P. Artificial total disc replacement versus fusion for the cervical spine: a systematic review. Eur Spine J, 2011, 20(2): 177-184.
  21. 21. 謝華, 徐南偉, 農(nóng)魯明, 等. Prodisc-C人工頸椎間盤置換術(shù)治療中老年頸椎病的療效. 江蘇醫(yī)學(xué), 2011, 37(6): 691-693.