【摘要】：研究目的:通過搜集評估Bryan人工頸椎間盤置換的臨床隨訪指標(biāo),測量分析術(shù)后相關(guān)影像學(xué)資料,探討人工頸椎間盤置換術(shù)治療頸椎病的遠(yuǎn)期臨床療效,及其對頸椎生理曲度、脊柱功能單位曲度、置換及臨近節(jié)段活動(dòng)度、脊柱功能單位活動(dòng)度及鄰近節(jié)段退變的影響進(jìn)行研究。研究方法:回顧性研究2010年08月至2013年08月期間北京中醫(yī)藥大學(xué)東直門醫(yī)院骨科行Bryan人工頸椎間盤假體植入的49例患者(男性26例,女性23例,平均年齡48.5歲,其中神經(jīng)根型21例,脊髓型16例,混合型12例,共61個(gè)病變節(jié)段,單節(jié)段置換21例,雙節(jié)段置換20例),術(shù)后1、3、6月視為早期隨訪,術(shù)后12、24、36個(gè)月視為遠(yuǎn)期隨訪,分別進(jìn)行臨床數(shù)據(jù)和影像學(xué)資料搜集。應(yīng)用Odom、VAS、JOA、NDI評分系統(tǒng)評估臨床療效和神經(jīng)功能改善狀況;通過頸椎影像學(xué)資料測量分析頸椎生理曲度、脊柱功能單位曲度、置換及臨近節(jié)段活動(dòng)度、脊柱功能單位活動(dòng)度及鄰近節(jié)段退變發(fā)生率。應(yīng)用SPSS18.0軟件,對相關(guān)資料進(jìn)行統(tǒng)計(jì)分析。研究結(jié)果:術(shù)后36個(gè)月后隨訪Odom評級為95.91%,術(shù)前及術(shù)后36個(gè)月隨訪,VAS評分分別為(7.26±1.45)分和(2.15±0.72)分,JOA評分分別為(8.9±2.11)分和(15.0±1.29)分,NDI評分分別為(38.10±7.09)分和(27.79±7.12)分,患者術(shù)后的JOA、VAS及NDI分值均較術(shù)前明顯改善,統(tǒng)計(jì)學(xué)分析具有顯著性差異(p0.05);患者術(shù)后頸椎的生理前凸曲度及脊柱功能單位曲度較術(shù)前明顯增大,術(shù)前頸椎生理前凸及脊柱功能單位曲度減小或消失狀況得到改善,術(shù)前與術(shù)后隨訪結(jié)果比較,統(tǒng)計(jì)學(xué)分析具有顯著性差異(p0.05);且早期與晚期隨訪結(jié)果比較,統(tǒng)計(jì)學(xué)分析具有顯著性差異(p0.05)。術(shù)后早期隨訪,頸椎活動(dòng)度、置換節(jié)段及臨近節(jié)段活動(dòng)度、脊柱功能單位活動(dòng)度均較術(shù)前降低,并且差異具有統(tǒng)計(jì)學(xué)意義。但術(shù)后12-36個(gè)月晚期隨訪以上活動(dòng)度可恢復(fù)至術(shù)前水平,同術(shù)前相比差異無統(tǒng)計(jì)學(xué)意義;術(shù)后36個(gè)月隨訪,鄰近節(jié)段退變發(fā)生率為12.24%。結(jié)論:Bryan人工頸椎間盤置換術(shù)不僅有良好遠(yuǎn)期臨床療效,同時(shí)也重建頸椎和脊柱功能單位的前凸曲度,恢復(fù)頸椎生物力學(xué)功能,保留頸椎整體運(yùn)動(dòng)功能,減少鄰近節(jié)段退變發(fā)生率。人工頸椎間盤置換術(shù)代表了一種全新的非融合理念,仍然需要多中心、大樣本、對比性的臨床研究和更長期的隨訪,相信其在臨床中的應(yīng)用將會(huì)越來越廣泛。
[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 鹵1.45) and (2.15 鹵0.72), the JOA score was (8.9 鹵2.11) and (15.0 鹵1.29), and the NDI score was (38.10 鹵7.09) and (27.79 鹵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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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