单节段颈椎人工椎间盘置换术治疗颈椎病的临床研究

目的:探讨单节段颈椎人工椎间盘置换术(CDA)治疗颈椎病的临床效果。方法:选择2013年5月到2015年5月在我院收治的80例颈椎病患者,按手术方式不同分为颈椎人工椎间盘置换组(CDA组)和前路颈椎减压融合组(ACDF组),各40例。两组患者均于术前、术后3个月、术后6个月及术后1年进行末期随访时,采用颈椎功能障碍指数(NDI)评价患者颈部功能,采用颈痛视觉模拟评分(VAS)和上肢痛VAS评价患者颈部疼痛,采用X线片在过伸和过屈位测量患者术前和术后手术节段相邻节段的活动度。结果:两组患者术后3个月、6个月及术后1年时的NDI评分、颈痛VAS及上肢痛VAS均明显低于术前,差异具有统计学意义(P0.05),然而两组间比较差异无统计学意义(P0.05)。CDA组患者术后3个月、6个月及术后1年时的手术相邻上节段活动度和手术相邻下节段活动度与术前比较差异无统计学意义(P0.05),而ACDF组患者术后3个月、6个月及术后1年时均明显高于术前及同期CDA组,差异具有统计学意义(P0.05)。结论:单节段CDA治疗颈椎病的临床疗效与ACDF相近,另外其不会引起手术相邻节段活动度的增加,值得在临床上推广应用。

The Clinical Study of the Single Level Cervical Disc Arthroplasty for Cervical Spondylosis Myelopathy

Objective:To explore the clinical effects of the single level cervical disc arthroplasty for the cervical disease.Methods:80 patients who have cervical spondylosis were selected from May 2013 to May 2015, which were divided two groups randomly according to the surgical approach. 40 patients was in CDA group(experimental group) and 40 patients in ACDF group(controlled group). Before operation 3, 6 and 12 months after operation, the patients were followed up. The neck fuction of patients were evaluated by neck disability index (NDI) preoperative and postoperative, the neck pain of patients were evaluated by visual analogue scale (VAS) preoperative and postoperative, the range of movement (ROM) in operation segement was determined by dynamic X-ray.Results:The NDI score, neck pain VAS and upper limb pain VAS after 3, 6 months and the end of the follow-up were significantly lower than the preoperative, the difference was statistically significant (P<0.05), but there was no statistical difference between the two groups(P>0.05). The range of movement of the CDA group after 3, 6 months and the end of the follow-up was no statistical difference with the preoperative(P>0.05). The range of movement of the ACDF group after 3,6 months and the end of the follow-up was statistical difference with the preoperative and the same period CDA group, the difference were statistically significant (P<0.05).Conclusion:The clinical efficacy of single segment CDA in treating cervical spondylosis is similar to that of ACDF, In addition, it will not cause the increase of the activity of adjacent segment, so it is worth popularizing in clinic.