颈椎前路DISCOVER人工椎间盘置换对比椎间融合治疗颈椎病的临床疗效分析

发布时间：2018-03-01 13:13

  本文关键词： 颈椎病 人工椎间盘置换术 颈椎前路减压融合术 对比疗效分析　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:颈椎前路减压融合内固定术(ACDF)造成手术节段活动度丧失,相邻节段应力集中及活动度代偿性增加,进而导致邻近椎间盘退变引起临床症状的病例越来越多,为了改善现状,近年来部分学者将手术治疗理念转移到非融合技术上,颈椎人工椎间盘置换(CDR)作为一种新型非融合技术而被重视,逐渐应用于临床并且取得了良好的效果,但随着随访时间的延长,其缺点也日渐暴露,目前有关颈椎前路减压融合内固定术(ACDF)与人工椎间盘置换术(CDR)临床疗效的对比研究逐渐展开,但尚未得出一致结论。目的:通过研究颈椎前路DISCOVER人工椎间盘置换与椎间融合内固定患者术后临床和影像学结果,对比两种术式治疗颈椎病的疗效。方法:回顾性分析2012年5月至2015年5月期间于青岛大学附属医院脊柱外科接受手术治疗的单节段颈椎病患者52例,因治疗方式不同随机分为颈椎人工椎间盘置换组(置换组)和颈椎前路减压融合内固定组(融合组),其中置换组26例,融合组26例,分别于治疗后3、12、24、36个月进行不同时间随访,应用日本矫形外科协会(JOA)评分、视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)评分等脊髓功能评价指标和颈椎曲度指数(CCI)、置换节段活动度、邻近节段活动度、异位骨化等影像学结果,进行统计学对比分析研究。结果:所有患者术后随访24-36个月不等,结果显示,两组患者治疗后各时间段的JOA、SF-36评分较治疗前增加(P0.05),VAS、NDI评分较治疗前减少(P0.05),但两组间比较差异无显著性意义(P0.05);置换组术后3月、12月及末次随访时Odom‘s优良率分别为92.3%、97.2%、97.2%,融合组术后3月、12月及末次随访时Odom‘s优良率分别为91.0%、95.4%、93.2%,两组术后优良率较治疗前均增加(P0.05),组间差异无显著意义(P0.05);置换组治疗后置换节段活动度(8.00±0.11)°与治疗前(8.04±1.06)°相比,差异无显著性意义(P0.05),融合组治疗后融合节段活动度近乎丧失,差异有显著性意义(P0.05);置换组治疗后颈椎整体活动度(43.37±5.25)°与治疗前(45.68±5.34)°差异无显著性意义(P0.05),而融合组治疗后颈椎整体活动度(38.96±4.26)°与治疗前(44.64±4.57)°差异有显著性意义(P0.05);置换组治疗后3月、12月及末次随访时段颈椎曲度指数(CCI)较术前比较差异无显著性意义(P0.05),融合组治疗后3月、12月及末次随访时颈椎曲度指数(CCI)较术前比较差异有显著性意义(P0.05),两组间各时间段对比差异有显著性意义(P0.05),置换组治疗后末次随访时置换节段上阶段活动度(8.72±1.50)°较术前(8.48±1.61)°、置换节段下阶段活动度(8.26±1.34)°较术前(8.09±1.59)°差异均无显著性意义(P0.05),融合组治疗后末次随访时融合节段上阶段活动度(10.78±1.30)°较术前(8.50±1.97)°、融合节段下阶段活动度(9.03±1.26)°较术前(7.74±1.39)°差异均有显著性意义(P0.05)。结论:DISCOVER颈椎人工椎间盘置换术(CDR)与颈椎前路减压融合内固定术(ACDF)相比,在缓解术后症状,恢复神经功能方面无显著差异,且患者术后早期即可恢复正常生活、工作,就短期随访而言,DISCOVER人工椎间盘置换术在保持颈椎置换节段的活动度,减少邻近节段椎间盘退变、维持颈椎曲度方面更具有优势。
[Abstract]:Background: anterior cervical decompression and fusion with internal fixation (ACDF) by segment activity loss, adjacent segment stress concentration and activity of the compensatory increase, leading to the adjacent intervertebral disc degeneration caused by the increasing number of cases of clinical symptoms, in order to improve the situation, in recent years, scholars will be transferred to the concept of non fusion surgery technically, cervical artificial disc replacement (CDR) and is regarded as a new type of non fusion technology is gradually applied in the clinic and achieved good results, but with longer follow-up, its disadvantages are also increasingly exposed, the anterior cervical decompression and fusion with internal fixation (ACDF) and artificial disc replacement (CDR) a comparative study of the clinical efficacy of the gradual, but has not yet reached the same conclusion. Objective: through the clinical research of anterior cervical DISCOVER artificial disc replacement and interbody fusion and internal fixation and postoperative imaging The results, the results of the two types of surgical treatment of cervical spondylosis. Methods: a retrospective analysis from May 2012 to May 2015 in 52 patients with single segmental cervical spine surgery of Affiliated Hospital of Qiingdao University underwent surgery cases, because of different treatment methods were randomly divided into artificial cervical intervertebral disc replacement group (replacement group) and anterior cervical decompression and fusion the internal fixation group (fusion group), including 26 cases of replacement group, fusion group 26 cases were treated after 3,12,24,36 months of follow-up time, using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI) score and the functional evaluation of cervical spinal cord curvature index (CCI), the replacement segment of the adjacent segment of the heterotopic ossification imaging, were statistically analyzed. Results: follow up ranged from 24-36 months in all patients after operation, results showed that, 涓ょ粍鎮ｈ，

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