非融合手术治疗颈椎间盘突出症

目的 探讨Bryan人工颈椎间盘假体置换治疗颈椎间盘突出症的临床效果.方法 本组34例颈椎间盘突出症患者,其中男21例,女13例;年龄31～57岁,平均43岁.突出部位:C3～4 2例,C4～5 4例,C5～6 22例,C6～7 1例,C4～5,5～6 2例,C3～4,5～6 2例,C5～6,6～7 1例.临床症状以脊髓压迫为主14例,神经根性症状为主20例.单节段置换29例,双节段置换5例,共置换39个椎间盘假体.Bryan假体由金属外壳和聚氨酯髓核组成,外壳有钛微孔喷涂层,可促进骨生长,达到长期稳定.术后摄颈椎动态x线片观察假体稳定性及活动度.依照CSM40分法评定神经功能.结果 本组患者术后随访3～42个月,平均14个月.全部患者神经功能均有明显改善,神经根型患者其上肢根型痛全部缓解.CSM40分法评分平均提高8.5分,有效率为100%,无假体松动或脱落,术后置换节段活动度平均为9.3°.结论 人工颈椎间盘置换术后能达到确切的稳定性,具有良好的活动度,术后神经功能恢复良好,为颈椎问盘突出症的治疗提供了新的选择方式.

Management of cervical disc herniation with nonfusion surgical technique

Objective To evaluate the clinical restdts of Bryan cervical disc prosthesis in treatment of cervical disc herniation. Methods There were 34 patients with cervical disc herniation.There were 13 females and 21 males at age range of 31-57 years(mean43 years).The herniated disc was located at C3-4 in 2 patients,at C4-5 in 4,at C5-6 in 22,at C6-7 in 1,at C4-5,5-6 in 2,C3.4.5-6 in 2 and C5-6,6-7 in 1.There were 14 patients with myelopathy and 20 with radiculopathy.A total of 39 sets of Bryan cervical disc prosthesis were implanted,with single level disc replaced in 29 patients and bi-level in 5.The Bryan cervical disc prosthesis contained a proprietary,low-friction,wear-resistant,unique polyurethane nucleus and a titanium plate(shells)that included convex porous ingrowth surfaces,to allow bony fixation to the adjacent vertebral endplates.The level of stableness and mobility at the implanting location were observed on dynamic radiograph postoperatively.The nerve function was evaluated by CSM40 score. Results The average follow-up was 14 months(3-42 months),which showed significant improvement in neurological symptoms in.all patients.Radicular pain for patients suffering from raduculopathy was relieved completely.The average CSM40 score was improved by 8.5 points.with efficiency rate of 100%.There was no prosthesis displacement or loosening in all patients,with mean range of motion(ROM)for 9.3 degrees at implant level on the flexion-extension radiographs. ConclusionImplantation of cervical disc prosthesis Can attain deftnite stabilization and satisfactory mobility,significantly improve neurological symptom and hence provides a new effective treatment for cervical disc herniation.