Bryan人工颈椎间盘置换的临床疗效和影像学分析
发布时间：2019-06-15 04:22
【摘要】：研究目的:通过搜集评估Bryan人工颈椎间盘置换的临床随访指标,测量分析术后相关影像学资料,探讨人工颈椎间盘置换术治疗颈椎病的远期临床疗效,及其对颈椎生理曲度、脊柱功能单位曲度、置换及临近节段活动度、脊柱功能单位活动度及邻近节段退变的影响进行研究。研究方法:回顾性研究2010年08月至2013年08月期间北京中医药大学东直门医院骨科行Bryan人工颈椎间盘假体植入的49例患者(男性26例,女性23例,平均年龄48.5岁,其中神经根型21例,脊髓型16例,混合型12例,共61个病变节段,单节段置换21例,双节段置换20例),术后1、3、6月视为早期随访,术后12、24、36个月视为远期随访,分别进行临床数据和影像学资料搜集。应用Odom、VAS、JOA、NDI评分系统评估临床疗效和神经功能改善状况;通过颈椎影像学资料测量分析颈椎生理曲度、脊柱功能单位曲度、置换及临近节段活动度、脊柱功能单位活动度及邻近节段退变发生率。应用SPSS18.0软件,对相关资料进行统计分析。研究结果:术后36个月后随访Odom评级为95.91%,术前及术后36个月随访,VAS评分分别为(7.26±1.45)分和(2.15±0.72)分,JOA评分分别为(8.9±2.11)分和(15.0±1.29)分,NDI评分分别为(38.10±7.09)分和(27.79±7.12)分,患者术后的JOA、VAS及NDI分值均较术前明显改善,统计学分析具有显著性差异(p0.05);患者术后颈椎的生理前凸曲度及脊柱功能单位曲度较术前明显增大,术前颈椎生理前凸及脊柱功能单位曲度减小或消失状况得到改善,术前与术后随访结果比较,统计学分析具有显著性差异(p0.05);且早期与晚期随访结果比较,统计学分析具有显著性差异(p0.05)。术后早期随访,颈椎活动度、置换节段及临近节段活动度、脊柱功能单位活动度均较术前降低,并且差异具有统计学意义。但术后12-36个月晚期随访以上活动度可恢复至术前水平,同术前相比差异无统计学意义;术后36个月随访,邻近节段退变发生率为12.24%。结论:Bryan人工颈椎间盘置换术不仅有良好远期临床疗效,同时也重建颈椎和脊柱功能单位的前凸曲度,恢复颈椎生物力学功能,保留颈椎整体运动功能,减少邻近节段退变发生率。人工颈椎间盘置换术代表了一种全新的非融合理念,仍然需要多中心、大样本、对比性的临床研究和更长期的随访,相信其在临床中的应用将会越来越广泛。
[Abstract]:Objective: to investigate the long-term clinical effect of artificial cervical disc replacement in the treatment of cervical spondylosis by collecting and evaluating the clinical follow-up indexes of Bryan artificial cervical disc replacement, and to investigate the long-term clinical effect of artificial cervical disc replacement in the treatment of cervical spondylosis, and its effects on cervical physiological curvature, spinal functional unit curvature, replacement and adjacent segment motion, spinal functional unit activity and adjacent segment degeneration. Methods: from August 2010 to August 2013, 49 patients (M 26, F 23, mean age 48.5 years, including 21 cases of nerve root type, 16 cases of spinal cord type, 12 cases of mixed type, 61 segments of lesion, 21 cases of single segment replacement and 20 cases of double segment replacement) were treated with Bryan artificial cervical disc replacement in the Department of Orthopaedics, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine. 12, 24 and 36 months after operation were regarded as long-term follow-up, and clinical data and imaging data were collected respectively. The clinical efficacy and neurological function improvement were evaluated by Odom,VAS,JOA,NDI scoring system, and the physiological curvature of cervical vertebrae, curvature of spinal functional units, motion of replacement and adjacent segments, range of motion of spinal functional units and the incidence of degeneration of adjacent segments were measured and analyzed by cervical imaging data. The related data were statistically analyzed by using SPSS18.0 software. Results: the Odom score was 95.91% 36 months after operation. The VAS score was (7.26 卤1.45) and (2.15 卤0.72), the JOA score was (8.9 卤2.11) and (15.0 卤1.29), and the NDI score was (38.10 卤7.09) and (27.79 卤7.12), respectively. The JOA,VAS and NDI scores of the patients were significantly improved compared with those before operation. There was significant difference in statistical analysis (p0.05). The physiological protrusions and spinal functional unit curvature of cervical vertebrae after operation were significantly higher than those before operation, and the preoperative cervical physiological kyphosis and spinal functional unit curvature decreased or disappeared. There was significant difference between preoperative and postoperative follow-up results (p0.05), and there was significant difference between early and late follow-up results (p0.05). Early follow-up showed that the range of motion of cervical vertebrae, the range of motion of replacement segment and adjacent segment, and the range of motion of spinal functional unit were significantly lower than those before operation, and the difference was statistically significant. However, the above range of activity could be returned to the preoperative level at the end of 12 months after operation, and there was no significant difference compared with that before operation, and the incidence of adjacent segment degeneration was 12.24% at 36 months after operation. Conclusion: Bryan artificial cervical disc replacement not only has a good long-term clinical effect, but also reconstructs the kyphosis of cervical and spinal functional units, recovers the biomechanical function of cervical vertebrae, preserves the overall motor function of cervical vertebrae, and reduces the incidence of degeneration of adjacent segments. Artificial cervical disc replacement represents a new concept of non-fusion, which still requires multicenter, large sample, comparative clinical research and longer-term follow-up. It is believed that its clinical application will be more and more extensive.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2499961
[Abstract]:Objective: to investigate the long-term clinical effect of artificial cervical disc replacement in the treatment of cervical spondylosis by collecting and evaluating the clinical follow-up indexes of Bryan artificial cervical disc replacement, and to investigate the long-term clinical effect of artificial cervical disc replacement in the treatment of cervical spondylosis, and its effects on cervical physiological curvature, spinal functional unit curvature, replacement and adjacent segment motion, spinal functional unit activity and adjacent segment degeneration. Methods: from August 2010 to August 2013, 49 patients (M 26, F 23, mean age 48.5 years, including 21 cases of nerve root type, 16 cases of spinal cord type, 12 cases of mixed type, 61 segments of lesion, 21 cases of single segment replacement and 20 cases of double segment replacement) were treated with Bryan artificial cervical disc replacement in the Department of Orthopaedics, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine. 12, 24 and 36 months after operation were regarded as long-term follow-up, and clinical data and imaging data were collected respectively. The clinical efficacy and neurological function improvement were evaluated by Odom,VAS,JOA,NDI scoring system, and the physiological curvature of cervical vertebrae, curvature of spinal functional units, motion of replacement and adjacent segments, range of motion of spinal functional units and the incidence of degeneration of adjacent segments were measured and analyzed by cervical imaging data. The related data were statistically analyzed by using SPSS18.0 software. Results: the Odom score was 95.91% 36 months after operation. The VAS score was (7.26 卤1.45) and (2.15 卤0.72), the JOA score was (8.9 卤2.11) and (15.0 卤1.29), and the NDI score was (38.10 卤7.09) and (27.79 卤7.12), respectively. The JOA,VAS and NDI scores of the patients were significantly improved compared with those before operation. There was significant difference in statistical analysis (p0.05). The physiological protrusions and spinal functional unit curvature of cervical vertebrae after operation were significantly higher than those before operation, and the preoperative cervical physiological kyphosis and spinal functional unit curvature decreased or disappeared. There was significant difference between preoperative and postoperative follow-up results (p0.05), and there was significant difference between early and late follow-up results (p0.05). Early follow-up showed that the range of motion of cervical vertebrae, the range of motion of replacement segment and adjacent segment, and the range of motion of spinal functional unit were significantly lower than those before operation, and the difference was statistically significant. However, the above range of activity could be returned to the preoperative level at the end of 12 months after operation, and there was no significant difference compared with that before operation, and the incidence of adjacent segment degeneration was 12.24% at 36 months after operation. Conclusion: Bryan artificial cervical disc replacement not only has a good long-term clinical effect, but also reconstructs the kyphosis of cervical and spinal functional units, recovers the biomechanical function of cervical vertebrae, preserves the overall motor function of cervical vertebrae, and reduces the incidence of degeneration of adjacent segments. Artificial cervical disc replacement represents a new concept of non-fusion, which still requires multicenter, large sample, comparative clinical research and longer-term follow-up. It is believed that its clinical application will be more and more extensive.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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