• 常熟市第一人民醫(yī)院骨科（江蘇常熟，215500）;

【摘 要】 目的  通過(guò)與頸前路減壓植骨內(nèi)固定術(shù)治療患者比較，探討應(yīng)用Discover人工頸椎間盤(pán)置換治療頸椎病的早期效果。 方法  回顧分析2010年3月－2011年3月24例符合選擇標(biāo)準(zhǔn)的神經(jīng)根型和脊髓型頸椎病患者臨床資料，按收治時(shí)間分為頸前路減壓融合組（融合組13例，2010年3月－2010年9月）和Discover人工頸椎間盤(pán)置換組（置換組11例，2010年9月－2011年3月）。兩組患者性別、年齡、病程、病變分型、病變節(jié)段等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。記錄手術(shù)時(shí)間、出血量、術(shù)后并發(fā)癥，采用日本骨科協(xié)會(huì)（JOA）改善率、頸椎功能障礙指數(shù)（NDI）、Odom’s評(píng)分評(píng)價(jià)療效；置換組于手術(shù)前后X線片上測(cè)量置換及其鄰近節(jié)段的過(guò)伸過(guò)屈、左右側(cè)屈活動(dòng)度，以及假體偏心距。 結(jié)果  兩組患者術(shù)后癥狀均緩解，未出現(xiàn)明顯并發(fā)癥。患者均獲隨訪，融合組隨訪時(shí)間12～18個(gè)月，平均15.3個(gè)月；置換組隨訪時(shí)間6～12個(gè)月，平均9.6個(gè)月。術(shù)后1、3、6個(gè)月置換組NDI均高于融合組（P  lt; 0.05），但JOA評(píng)分改善率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。末次隨訪時(shí)融合組Odom’s評(píng)分為優(yōu)6例，良4例，可3例，優(yōu)良率76.92%；置換組為優(yōu)9例，良1例，差1例，優(yōu)良率90.91%；兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義（χ2=3.000，P=0.223）。術(shù)后置換組過(guò)伸過(guò)屈及右側(cè)屈活動(dòng)度于1個(gè)月時(shí)明顯減?。≒  lt; 0.05），之后逐漸恢復(fù)；左側(cè)屈活動(dòng)度呈先增加后減少趨勢(shì)，其中3、6個(gè)月時(shí)較術(shù)前明顯增加（P  lt; 0.05）。術(shù)后置換節(jié)段和上位節(jié)段左側(cè)屈活動(dòng)度大于右側(cè)屈（P  lt; 0.05），且上位節(jié)段左、右側(cè)屈活動(dòng)度差約為置換節(jié)段的2倍；側(cè)屈活動(dòng)度差與假體偏心距成正相關(guān)（P  lt; 0.05），且假體偏向側(cè)的側(cè)屈活動(dòng)度增大，對(duì)側(cè)活動(dòng)度減小。 結(jié)論  Discover人工頸椎間盤(pán)置換術(shù)是一種簡(jiǎn)便、安全且能保留頸椎活動(dòng)的手術(shù)，早期療效較好。

引用本文： 錢(qián)宇鋒,薛峰,盛曉文,陸建民,陳兵乾. Discover人工頸椎間盤(pán)置換治療頸椎病的初步應(yīng)用. 中國(guó)修復(fù)重建外科雜志, 2012, 26(3): 277-283. doi: 復(fù)制

1. C artificial disc investigational device exemption study with a minimum 2-year follow-up. J Neurosurg Spine, 2011, 15(4): 348-358.
2. Duggal N. Cervical disc arthroplasty: a practical overview. Curr Orthop Pract, 2009, 20(3): 216-221. 2 田偉, 劉波, 李勤. 人工椎間盤(pán)置換手術(shù)的臨床初步應(yīng)用體會(huì). 中華醫(yī)學(xué)雜志, 2005, 85(1): 37-40.
3. Hukuda S, Mochizuki T, Ogata M, et al. Operations for cervical spondylotic myelopahty. A comparison of the results of anterior and posterior procedures. J Bone Jiont Surg (Br), 1985, 67(4): 609-615.
4. 伍少玲, 馬超, 伍時(shí)玲. 頸椎功能障礙指數(shù)量表的效度與信度研究. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2008, 23(7): 625-628.
5. Greiner-Perth R, Allam Y, Silbermann J. First experience and preliminary clinical results with the cervical disc replacement discover. Z Orthop Unfall, 2009, 147(5): 582-587.
6. White AA 3rd, Panjabi MM. The basic kinematics of the human spine. A review of past abd current knowledge. Spine (Phila Pa 1976), 1978, 3(1): 12-20.
7. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976), 2009, 34(2): 101-107.
8. Coric D, Nunley PD, Guyer RD, et al. Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex.
9. Park DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976), 2011, 36(9): 721-730.
10. Ahn PG, Kim KN, Moon SW, et al. Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years. J Neurosurg Spine, 2009, 11(6): 688-695.
11. Cardoso MJ, Rosner MK. Multilevel cervical arthroplasty with artificial disc replacement. Neurosurg Focus, 2010, 28(5): E19.
12. Anderson PA, Sasso RC, Riew KD. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine (Phila Pa 1976), 2008, 33(12): 1305-1312.
13. Lee JH, Jung TG, Kim HS, et al. Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement. Spine J, 2010, 10(8): 676-682.
14. Du J, Li M, Liu H, et al. Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis. Spine J, 2011, 11(4): 281-289.
15. 段麗群, 張文志, 尚希福, 等. Discover人工頸椎間盤(pán)置換在頸椎病治療中的初期療效觀察. 頸腰痛雜志, 2011, 32(1): 9-13.
16. Galbusera F, Anasetti F, Bellini CM. The influence of the axial, antero-posterior and lateral positions of the center of rotation of a ball-and-socket disc prosthesis on the cervical spine biomechanics. Clin Biomech (Bristol Avon), 2010, 25(5): 397-401.
17. Chang UK, Kim DH, Lee MC, et al. Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 40-46.
18. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.19 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.
19. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4 (6 Suppl): S190-194.
20. Jawahar A, Cavanaugh 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.
21. Jiang H, Zhu Z, Qiu Y, et al. Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg, 2012, 132(2): 141-145.
22. 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.
  1. 1. C artificial disc investigational device exemption study with a minimum 2-year follow-up. J Neurosurg Spine, 2011, 15(4): 348-358.
  2. 2. Duggal N. Cervical disc arthroplasty: a practical overview. Curr Orthop Pract, 2009, 20(3): 216-221. 2 田偉, 劉波, 李勤. 人工椎間盤(pán)置換手術(shù)的臨床初步應(yīng)用體會(huì). 中華醫(yī)學(xué)雜志, 2005, 85(1): 37-40.
  3. 3. Hukuda S, Mochizuki T, Ogata M, et al. Operations for cervical spondylotic myelopahty. A comparison of the results of anterior and posterior procedures. J Bone Jiont Surg (Br), 1985, 67(4): 609-615.
  4. 4. 伍少玲, 馬超, 伍時(shí)玲. 頸椎功能障礙指數(shù)量表的效度與信度研究. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2008, 23(7): 625-628.
  5. 5. Greiner-Perth R, Allam Y, Silbermann J. First experience and preliminary clinical results with the cervical disc replacement discover. Z Orthop Unfall, 2009, 147(5): 582-587.
  6. 6. White AA 3rd, Panjabi MM. The basic kinematics of the human spine. A review of past abd current knowledge. Spine (Phila Pa 1976), 1978, 3(1): 12-20.
  7. 7. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976), 2009, 34(2): 101-107.
  8. 8. Coric D, Nunley PD, Guyer RD, et al. Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex.
  9. 9. Park DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976), 2011, 36(9): 721-730.
  10. 10. Ahn PG, Kim KN, Moon SW, et al. Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years. J Neurosurg Spine, 2009, 11(6): 688-695.
  11. 11. Cardoso MJ, Rosner MK. Multilevel cervical arthroplasty with artificial disc replacement. Neurosurg Focus, 2010, 28(5): E19.
  12. 12. Anderson PA, Sasso RC, Riew KD. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine (Phila Pa 1976), 2008, 33(12): 1305-1312.
  13. 13. Lee JH, Jung TG, Kim HS, et al. Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement. Spine J, 2010, 10(8): 676-682.
  14. 14. Du J, Li M, Liu H, et al. Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis. Spine J, 2011, 11(4): 281-289.
  15. 15. 段麗群, 張文志, 尚希福, 等. Discover人工頸椎間盤(pán)置換在頸椎病治療中的初期療效觀察. 頸腰痛雜志, 2011, 32(1): 9-13.
  16. 16. Galbusera F, Anasetti F, Bellini CM. The influence of the axial, antero-posterior and lateral positions of the center of rotation of a ball-and-socket disc prosthesis on the cervical spine biomechanics. Clin Biomech (Bristol Avon), 2010, 25(5): 397-401.
  17. 17. Chang UK, Kim DH, Lee MC, et al. Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 40-46.
  18. 18. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.19 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.
  19. 19. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4 (6 Suppl): S190-194.
  20. 20. Jawahar A, Cavanaugh 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.
  21. 21. Jiang H, Zhu Z, Qiu Y, et al. Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg, 2012, 132(2): 141-145.
  22. 22. 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.