摘要
目的探讨单节段Pro Disc-C人工颈椎间盘置换术的临床疗效以及术后置换节段屈伸活动旋转中心（center of rotation,COR）的位置变化及其临床意义。方法回顾分析2010年6月-2012年2月收治的23例行单节段Pro Disc-C人工颈椎间盘置换术患者临床资料。男9例,女14例;年龄27-65岁,平均45岁。病程10-84个月,平均25个月。其中神经根型颈椎病15例,脊髓型颈椎病5例,混合型颈椎病3例。病变节段：C4、5 5例,C5、6 14例,C6、7 4例。采用日本骨科学会评分（JOA）及颈椎功能障碍指数（NDI）评价临床疗效;比较术前和末次随访时颈椎整体活动度、置换节段及相邻节段活动度、椎间隙高度以及置换节段屈伸活动COR位置坐标（COR-X,COR-Y）的变化;比较分析COR位置变化与术后临床疗效以及影像学指标之间的关系。结果 23例患者均顺利完成手术,其中1例术后出现声嘶,术后3个月症状消失。患者均获随访6-36个月,平均18.3个月。末次随访时假体无移位、松动、下沉及断裂。末次随访时JOA评分较术前显著增加,NDI评分较术前显著减少,差异均有统计学意义（P〈0.05）。与术前比较,末次随访时颈椎整体活动度,置换节段活动度,上、下相邻节段活动度以及置换节段COR-Y差异均无统计学意义（P〉0.05）;椎间隙高度、置换节段COR-X显著增加（P〈0.05）。置换节段COR-X变化与术后JOA、NDI、置换节段活动度均无明显相关性（P〉0.05）。根据手术前后COR-X之差是否小于均值1.86 mm将患者分为两组,两组间术后置换节段活动度差异有统计学意义（P〈0.05）,而两组间术后JOA、NDI、颈椎整体活动度、邻近节段活动度及椎间隙高度差异均无统计学意义（P〉0.05）。结论单节段Pro Disc-C人工颈椎间盘置换术临床疗效满意,能有效维持颈椎整体活动度、置换节段和相邻节段活动度,增加置换节段的椎间隙高度。术后置换节段矢状
Objective To evaluate the effectiveness of the single segmental cervical disc replacement with Pro Disc-C,and to explore the location change of the flexion/extension center of rotation（COR） of the target level as well as its clinical significance. Methods Between June 2010 and February 2012,23 patients underwent single segmental cervical disc replacement with Pro Disc-C,and the clinical data were retrospectively analyzed. Of 23 patients,9 were male,and 14 were female with the age range from 27 to 65 years（mean,45 years）,and the disease duration ranged from 10 to 84 months（mean,25 months）. There were 15 patients with radiculopathy,5 patients with myelopathy,and 3 patients with mixed cervical spondylosis. The involved segments were C4,5 in 5 cases,C5,6 in 14 cases,and C6,7 in 4 cases. Japanese Orthopaedic Association（JOA） score and neck disability index（NDI） were adopted to evaluate the effectiveness. Preoperative and Postoperative radiographic parameters,such as cervical overall range of motion（ROM）,target segmental ROM,the adjacent segmental ROM,and intervertebral height were compared. Besides,the location changes of the COR of the target level were further analyzed by the alteration of its coordinates（COR-X,COR-Y）,and the relationships between the location changes of the COR and the effectiveness or the radiographic results were analyzed. Results All the operations were completed successfully; 1 case had hoarseness after operation,which disappeared at 3 months after operation. All cases were followed up 18.3 months on average（range,6-36 months）. There was no device migration,loosening,subsidence,or fracture at last follow-up. The JOA score increased significantly and the NDI score decreased significantly at last follow-up when compared with preoperative scores（P〈0.05）. No difference was found in the cervical overall ROM,target segmental ROM,the adjacent segmental ROM,and the COR-Y of the target level between pre-operation and last follow-up（P〉0.05）; while the intervert
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第1期48-53,共6页
Chinese Journal of Reparative and Reconstructive Surgery
