石銳 1 , 劉浩 1 , 丁琛 1 , 胡韜 1 , 李濤 1 , 龔全 1 , 宋躍明 1 , 洪瑛 2
  • 四川大學(xué)華西醫(yī)院（成都，610041）1 骨科，2 手術(shù)室;

【摘要】　目的　 評價Bryan人工椎間盤單節(jié)段置換治療頸椎間盤退變性疾病的臨床療效。　方法　 2004年11月—2008年4月，21例頸椎間盤退變突出并經(jīng)保守治療無效的患者接受Bryan人工頸椎間盤單節(jié)段置換術(shù)?；颊咝g(shù)前、術(shù)后1、6、12、18、24個月時使用頸椎功能障礙指數(shù)（neck disable index，NDI）、癥狀程度主觀評價、疼痛視覺模擬疼痛量表（visual analogue scale，VAS）進行療效評估，手術(shù)效果使用Odom法評價。影像學(xué)檢查包括頸椎功能位X線片、頸椎CT及MRI檢查。　結(jié)果　 21例患者均順利完成椎間盤置換手術(shù)，術(shù)后隨訪2年?；颊邔ΠY狀的主觀評分，頸痛VAS評分、手臂疼痛VAS評分，NDI分別由術(shù)前的（2.80±0.42）、（4.62±1.84）、（5.01±1.79）、（22.60±4.88）分下降到隨訪終止時的（0.20±0.42）、（1.01±0.56）、（0.82±0.24）、（4.30±1.25）分。所有患者對手術(shù)效果Odom 評級優(yōu)良，8例（38.1%）自覺癥狀完全緩解。手術(shù)過程平均時間為（110.5±42.6） min，術(shù)中出血量平均為（166.0±108.8） mL。影像學(xué)評價見植入的人工椎間盤運動功能良好，未見頸椎不穩(wěn)的表現(xiàn)。2例假體在術(shù)后早期輕度前移。　結(jié)論　 Bryan人工椎間盤單節(jié)段置換是治療頸椎間盤退變性疾病的一種安全有效的方法，術(shù)后隨訪2年臨床療效滿意。
【Abstract】　Objective　 To evaluate the clinical therapeutic effect of single segment Bryan disc replacement on cervical disc degenerative diseases.　Methods　 From November 2004 to April 2008, 21 patients who had a poor response after conservative treatment for their cervical disc degeneration underwent the single level Bryan disc replacement. Before the operation and 1, 6, 12, 18, and 24 months after the operation, all patients were evaluated by neck disable index (NDI), subjective symptom scale, visual analogue scale (VAS) and Odom score. The radiological examinations included X-ray, CT scan and MRI.　Results　 Operations were successfully executed in 21 patients. All patients had obeyed the follow-up visiting at the expected time in the next two years after the operation. Patients′ symptom scale, VAS for neck pain, VAS for arm pain, NDI were 2.80±0.42, 4.62±1.84, 5.01±1.79, and 22.60±4.88, respectively before the operation and significantly decreased to 0.20±0.42, 1.01±0.56, 0.82±0.24, and 4.30±1.25, respectively at the end of the follow-up. All patients had good or higher score of the Odom score. The ymptoms were completely relieved in eight patients (38.1%). The mean operation time was (110.5±42.6) minutes, the average blood loss was (166.0±108.8) mL. The normal motion of the artificial disc was observed. No cervical instability was observed. Two prosthesis migrated slightly.　Conclusion　 Single segmental Bryan disc replacement is safe and effective on the cervical disc degeneration. The two-year follow-up reveales a satisfied clinical outcome.

引用本文： 石銳,劉浩,丁琛,胡韜,李濤,龔全,宋躍明,洪瑛. Bryan人工椎間盤單節(jié)段置換治療頸椎間盤退變性疾病的臨床療效. 華西醫(yī)學(xué), 2011, 26(6): 885-889. doi: 復(fù)制

1. 　Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients[J]. J Bone Joint Surg Am, 1993, 75(9): 1298-1307.
2. 　Emery SE, Bohlman HH, Bolesta MJ, et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy:two to seventeen-year follow-up[J]. J Bone Joint Surg Am, 1998, 80(7): 941-951.
3. 　Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications[J]. Spine, 2007, 32(21): 2310-2317.
4. 　Bryan VE Jr. Cervical motion segment replacement[J]. Eur Spine J, 2002, 11( Suppl 2): 92-97.
5. 　Sasso RC, Best NM, Metcalf NH, et al. Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial[J]. J Spinal Disord Tech, 2008, 21(6): 393-399.
6. 　Sasso RC, Best NM. Cervical kinematics after fusion and bryan disc arthroplasty[J]. J Spinal Disord Tech, 2008, 21(1): 19-22.
7. 　Ishihara H, Kanamori M, Kawaguchi Y, et al. Adjacent segment disease after anterior cervical interbody fusion[J]. Spine J, 2004, 4(6): 624-628.
8. 　Anderson PA, Sasso RC, Riew KD. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis[J]. Spine, 2008, 33(12): 1305-1312.
9. 　Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis[J]. J Bone Joint Surg Am, 1999, 81(4): 519-528.
10. 　Brodke DS, Zdeblick TA. Modified smith-robinson procedure for anterior cervical discectomy and fusion[J]. Spine, 1992, 17(Suppl 10): 427-430.
11. 　Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan cervical disc prosthesis[J]. Neurosurgery, 2002, 51(3): 840-847.
12. 　Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level[J]. Spine, 2003, 28(24): 2673-2678.
13. 　Coric D, Finger F, Boltes P. Prospective randomized controlled study of the Bryan cervical disc: early clinical results from a single investigational site[J]. J Neurosurg Spine, 2006, 4(1): 31-35.
14. 　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[J]. Spine (Phila Pa 1976), 2009, 34(2): 101-107.
15. 　Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study[J]. J Neurosurg Spine, 2005, 3(6): 417-423.
16. 　Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients[J]. Spine, 2007, 32(26): 2933-2942.
17. 　Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up[J]. J Spinal Disord Tech, 2010, 23(6): 367-371.
18. 　農(nóng)魯明, 周棟, 徐南偉. 人工頸椎間盤置換術(shù)治療頸椎病的中期療效觀察[J]. 中國脊柱脊髓雜志, 2010, (7): 567-571.
19. 　Ren X, Wang W, Chu T, et al. The intermediate clinical outcome and its limitations of bryan cervical arthroplasty for treatment of cervical disc herniation[J]. J Spinal Disord Tech, 2011, 24(4): 221-229.
20. 　田偉, 韓驍, 劉波, 等. 術(shù)前因素對人工頸椎間盤置換術(shù)中期療效的影響[J]. 中華外科雜志, 2010, 48(2): 108-111.
21. 　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]. J Neurosurg Spine, 2007, 7(1): 33-39.
22. 　Yang S, Wu X, Hu Y, et al. Early and intermediate follow-up results after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single-and multiple-level[J]. Spine, 2008, 33(12): 371-377.
  1. 1. 　Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients[J]. J Bone Joint Surg Am, 1993, 75(9): 1298-1307.
  2. 2. 　Emery SE, Bohlman HH, Bolesta MJ, et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy:two to seventeen-year follow-up[J]. J Bone Joint Surg Am, 1998, 80(7): 941-951.
  3. 3. 　Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications[J]. Spine, 2007, 32(21): 2310-2317.
  4. 4. 　Bryan VE Jr. Cervical motion segment replacement[J]. Eur Spine J, 2002, 11( Suppl 2): 92-97.
  5. 5. 　Sasso RC, Best NM, Metcalf NH, et al. Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial[J]. J Spinal Disord Tech, 2008, 21(6): 393-399.
  6. 6. 　Sasso RC, Best NM. Cervical kinematics after fusion and bryan disc arthroplasty[J]. J Spinal Disord Tech, 2008, 21(1): 19-22.
  7. 7. 　Ishihara H, Kanamori M, Kawaguchi Y, et al. Adjacent segment disease after anterior cervical interbody fusion[J]. Spine J, 2004, 4(6): 624-628.
  8. 8. 　Anderson PA, Sasso RC, Riew KD. Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis[J]. Spine, 2008, 33(12): 1305-1312.
  9. 9. 　Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis[J]. J Bone Joint Surg Am, 1999, 81(4): 519-528.
  10. 10. 　Brodke DS, Zdeblick TA. Modified smith-robinson procedure for anterior cervical discectomy and fusion[J]. Spine, 1992, 17(Suppl 10): 427-430.
  11. 11. 　Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan cervical disc prosthesis[J]. Neurosurgery, 2002, 51(3): 840-847.
  12. 12. 　Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level[J]. Spine, 2003, 28(24): 2673-2678.
  13. 13. 　Coric D, Finger F, Boltes P. Prospective randomized controlled study of the Bryan cervical disc: early clinical results from a single investigational site[J]. J Neurosurg Spine, 2006, 4(1): 31-35.
  14. 14. 　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[J]. Spine (Phila Pa 1976), 2009, 34(2): 101-107.
  15. 15. 　Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study[J]. J Neurosurg Spine, 2005, 3(6): 417-423.
  16. 16. 　Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients[J]. Spine, 2007, 32(26): 2933-2942.
  17. 17. 　Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up[J]. J Spinal Disord Tech, 2010, 23(6): 367-371.
  18. 18. 　農(nóng)魯明, 周棟, 徐南偉. 人工頸椎間盤置換術(shù)治療頸椎病的中期療效觀察[J]. 中國脊柱脊髓雜志, 2010, (7): 567-571.
  19. 19. 　Ren X, Wang W, Chu T, et al. The intermediate clinical outcome and its limitations of bryan cervical arthroplasty for treatment of cervical disc herniation[J]. J Spinal Disord Tech, 2011, 24(4): 221-229.
  20. 20. 　田偉, 韓驍, 劉波, 等. 術(shù)前因素對人工頸椎間盤置換術(shù)中期療效的影響[J]. 中華外科雜志, 2010, 48(2): 108-111.
  21. 21. 　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]. J Neurosurg Spine, 2007, 7(1): 33-39.
  22. 22. 　Yang S, Wu X, Hu Y, et al. Early and intermediate follow-up results after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single-and multiple-level[J]. Spine, 2008, 33(12): 371-377.