ActivC人工颈椎间盘置换术与颈前路椎间盘切除融合治疗单节段颈椎病的早期疗效比较

目的:观察比较Activ C人工颈椎间盘置换术(ACDR)和颈前路椎间盘切除融合(ACDF)治疗单节段颈椎病的早期临床效果。方法:自2009年7月至2012年9月,76例单节段颈椎病患者接受Activ C人工颈椎间盘置换手术(置换组)或颈前路椎间盘切除融合手术(融合组).其中置换组28例,男18例,女10例,年龄32～62岁,平均(45.2±6.2)岁;融合组48例,男28例,女20例,年龄33～60岁,平均(45.8±6.4)岁。分别在术前,术后1周,术后3、6、12、24个月,对患者进行疼痛视觉模拟评分(VAS)、日本矫形外科协会(JOA)脊髓功能评分和生活质量量表(SF-36)评估及影像学评估。结果:76例患者均获得随访,时间6～24个月,平均13.2个月。颈痛、上肢痛的VAS评分及JOA评分,术后均有改善(p<0.05),两组间差异无统计学意义(p>0.05).两组患者SF-36躯体评分、精神评分术后均有明显上升(p<0.05),置换组优于融合组(p<0.05).置换组术后手术节段及邻近节段屈伸活动度与术前比较差异无统计学意义(p>0.05).置换组中1例患者在6个月时椎体后缘周围出现异位骨化,1年随访时暂无融合现象;融合组中1例患者发生邻椎病并接受二次手术治疗。结论:单节段Activ C人工颈椎间盘置换术早期临床效果满意,能减少邻近节段退变,远期效果有待临床进一步研究。

Comparison of early clinical effects between Activ C cervical disc replacement and anterior cervical discectomy and fusion for single-level cervical spondylosis

Objective:To compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis. Methods:The clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them,28 patients were treated with ACDR(ACDR group),including 18 males and 10 females,aged from 32 to 62 years old with an average of (45.2±6.2) years;and 48 patients were treated with ACDF(ACDF group),including 28 males and 20 females,aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale(VAS),Japanese Orthopedics Association(JOA) score,Short Form-36 (SF-36),imaging data were used to assess the clinical effects after operation. Results:A total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (p<0.05),there was no significant difference between two group(p>0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased(p<0.05),ACDR group was better than that of ACDF group(p<0.05). In ACDR group,there was no significant difference in the range of motion of surgical segments and adjacent segments between preoperative and postoperative(p>0.05);heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation,no fusion was found on the 1st year after operation. In ACDF group,the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation. Conclusion:Activ C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory,but the long-term effects still need study.