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颈人工椎间盘置换术治疗颈椎病的早期疗效
作者：第二军医大学附属长征医院骨科陈雄生等
来源：2012COA大会论文汇编
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&&& 目的：在患者实施颈椎后，分别随机使用Discover颈人工椎间盘置换术和椎间隙，前瞻性评价DISCOVERTM颈人工椎间盘置换术的早期疗效。
　　方法：选取颈5/6椎间隙退变引起的颈椎病作为研究对象，共36例，按入院顺序随机均分为两组，所有患者均实施C5-6椎间盘切除减压术，Discover组采用DISCOVERTM颈人工椎间盘置换术修复减压区，ACDF组采用Cage植骨加钛板内固定融合术，术后2年作为早期临床疗效观察的端点。术前和术后随访的颈部疼痛、神经功能改善状况分别用VAS和JOA评分进行评价。对术前、术后6个月和术后2年的颈椎中立侧位、屈曲位和伸展位X线片进行测量，比较C4/5、C6/7椎间隙成角和C2-7节段Cobb角角度运动范围（range of motion&ROM）评价不同术式对颈椎活动影响；比较Discover组术前和术后24个月C5-6、C4-5、C6-7、C2-7节段Cobb角的变化，观察对颈椎生理曲度的影响。
　　结果：所有患者均获得至少2年随访。组内比较，两组JOA评分均在术后6月内改善（P&0.05），之后改善不明显；组间JOA&评分差异不明显（P＞0.05）。各组组内颈部疼痛改善明显，VAS评分存在统计学差异（P＜0.05），组间VAS&评分差异不明显（P＞0.05）。C4/5、C6/7和C2-7&ROM组内比较，&Discover组差异不明显（P＞0.05），ACDF组C4/5&ROM术后6月增加明显（P＜0.05），C2-7&ROM术后下降明显（P＜0.05）；组间比较，术后6月、12月Discover组C2-7&ROM明显增加（P＜0.05）。&术后24月Discover组C5-6和C4-5节段前凸角（Cobb&s角）改善较术前明显（P＜0.05）。&Discover组中有2例患者出现假体轻度下沉；ACDF组中有3例出现钛网下沉，无患者出现植骨不愈合、畸形愈合等并发症。但所有患者JOA、VAS评分均得到明显改善，无神经损伤、无颈椎后凸加重和假体松动等并发症发生。
　　结论：DISCOVERTM颈人工椎间盘治疗颈椎病在术后2年内获得良好的临床治疗效果；在保留颈椎活动度的情况下，能改善置换节段和上位相邻节段生理前凸角；与ACDF比较，能减轻上位相邻椎间隙的运动负荷。
颈椎病,减压,前路,颈椎人工椎间盘,植骨融合术,内固定术
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Spine系统评价：颈椎病各种治疗方法的有效性比较
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摘要：颈椎间盘突出是临床上较为常见的脊柱疾病之一发病仅次于腰椎间盘突出的治疗方法和其它脊柱疾病的一样分为保守治疗与手术治疗但关于治疗方法有效性的研究仍鲜有报道为此荷兰学者等进行了一项系统评价系统性评估各种治疗方法的有效性该研究结果发表在最新一期的杂志上作者搜索了
颈椎病（原文为颈椎间盘突出，cervical disc herniation, CDH，见后注）是临床上较为常见的脊柱疾病之一，发病仅次于腰椎间盘突出症。CDH的治疗方法和其它脊柱疾病的一样，分为保守治疗与手术治疗，但关于CDH治疗方法有效性的研究仍鲜有报道。为此，荷兰学者Lukas Gebremariam等进行了一项系统评价，系统性评估CDH各种治疗方法的有效性，该研究结果发表在最新一期的Spine杂志上。作者检索了Cochrane Library, MEDLINE,EMBASE, PEDro与CINAHL几大数据库中2009年2月以来相关的系统回顾以及随机临床试验(randomized clinical trials, RCTs)，并由两名评价者独立选择相关的研究，评价其文献质量并提取数据。最后共纳入了11项随机对照实验，其中1项为保守与手术治疗有效性的对照研究，其余10项则比较了不同的手术方式的有效性。结果发现，保守治疗（非甾体类抗炎药、激素和理疗）与经皮髓核成形术疗效比较尚缺乏有效的研究证据。而关于颈椎前路椎间盘切除融合术（ACDF）应用钛网作为椎间融合器（titanium cage）与ACDF应用聚甲基丙烯酸甲酯疗效的对比，以及Bryan颈椎间盘（美敦力公司）与同种异体骨联合钢板对比的研究证据均为中等。在ACD与ACDF疗效的对比中，仍有些证据相互矛盾。而关于其他手术治疗的疗效，或是证据有限，或是缺乏证据。因此，尽管有中等证据支持手术干预，但是缺乏确凿的证据证明哪一种手术方式存在优越性，而BRYAN置换仅在长期有效性上稍优于ACDF。此外，单纯椎间盘切除不植骨，因其手术效果与植骨效果相近，但费用较低、相邻节段蜕变的可能性低，因此更值得推荐。通过这项研究，使脊柱外科医生对CDH治疗方法有效性有了更清楚的认识，有利于医生选择合适的治疗方法，从而进一步提高CDH治疗效果。表1. 纳入的RCTs的方法学质量分数（Methodological Quality Scores）表2. 颈椎椎间盘突出干预手段有效性的证据表3. 纳入的RCTs的疗效测量指标和测量结果Evaluation of Treatment Effectiveness for the Herniated Cervical Disc: A Systematic Review.编者注：原文为&cervical disc herniation&，直译即为&颈椎间盘突出&。然而，在正常人群中，尤其是老年人群中，无症状的颈椎间盘突出并不少见，因此并不能将&颈椎间盘突出&视为一种疾病，而只是脊柱退变过程中的一种病理表现，临床通常也不需要任何干预。这种情况显然与原文不符。参考该研究纳入的相关文献，包括了脊髓型颈椎病、神经根型颈椎病等各种类型的颈椎病，因此，这里将该病名以&颈椎病&替代。
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-------------------The efficacy of plate construct augmentation versus cage alone in a...
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2009 Dec 15;34(26):2886-92. doi: 10.1097/BRS.0b013ec.The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion.1, , , , .1Department of Orthopaedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University School of Medicine, Jeonju, Korea.AbstractSTUDY DESIGN.: Retrospective study. OBJECTIVE.: To compare the efficacy of anterior cervical discectomy and fusion with cage alone (ACDF-CA) with cage and plate construct (ACDF-CPC) in regards to fusion rate, radiologic and clinical outcomes. SUMMARY OF BACKGROUND DATA.: ACDF-CA ha however, debate exists regarding the high rate of complications such as pseudarthrosis, subsidence, and local kyphosis. In an attempt to avoid these complications, the authors have performed ACDF with cage and plate construct (ACDF-CPC). METHODS.: A total of 78 consecutive patients who underwent 1- or 2-level ACDF-CA or ACDF-CPC suffering from cervical radiculopathy were divided into 2 Group A (n = 38) underwent ACDF-CA; Group B (n = 40) underwent ACDF-CPC. Fusion rate, segmental kyphosis, disc height, and subsidence rate were assessed by radiographs. Clinical outcomes were assessed using Robinson criteria. RESULTS.: Solid fusion was achieved in 78.9% (30/38) of subjects in group A compared to 97.5% (39/40) of subjects in group B (P = 0.01). Segmental kyphosis was noted in 42.1% (16/38) in group A compared with 10% (4/40) in group B (P & 0.01). There was a significant decrease in disc height in group A compared to group B (P & 0.05). Subsidence occurred in 32.3% (19/59 levels) of group A compared with 9.7% (6/62 levels) of group B (P & 0.01). Clinical outcomes were similar for both treatment groups. The pseudarthrosis rate in group A was higher than that in group B (P = 0.01). Revision surgery was required in 10.5% (4/38) of group A, whereas none of group B required reoperation (P & 0.01). CONCLUSION.: The use of cage and plate construct in 1- or 2-level ACDF results in a more lordotic alignment, an increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rate tha however, there is no significant difference in clinical outcome between groups.PMID:
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FormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListApplyChoose DestinationFileClipboardCollectionsE-mailOrderMy BibliographyCitation managerFormatSummary (text)Abstract (text)MEDLINEXMLPMID ListCSVCreate File1 selected item: FormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListMeSH and Other DataE-mailSubjectAdditional textE-mailAdd to ClipboardAdd to CollectionsOrder articlesAdd to My BibliographyGenerate a file for use with external citation management software.Create File
):342-6. doi: 10.3340/jkns..342. Epub
2010 Oct 30.Comparison of fusion with cage alone and plate instrumentation in two-level cervical degenerative disease.1, , , , .1Department of Neurosurgery, Cheongju St. Mary's Hospital, Cheongju, Korea.AbstractOBJECTIVE: This study assessed the efficacy of anterior cervical discectomy and fusion (ACDF) with cage alone compared with ACDF with plate instrumentation for radiologic and clinical outcomes in two-level cervical degenerative disease.METHODS: Patients with cervical degenerative disc disease from September 2004 to December 2009 were assessed retrospectively. A total of 42 patients received all ACDF at two-level cervical lesion. Twenty-two patients who underwent ACDF with cage alone were compared with 20 patients who underwent ACDF with plate fixation in consideration of radiologic and clinical outcomes. Clinical outcomes were assessed using Robinson's criteria and posterior neck pain, arm pain described by a 10 point-visual analog scale. Fusion rate, subsidence, kyphotic angle, instrument failure and the degenerative changes in adjacent segments were examined during each follow-up examination.RESULTS: VAS was checked during each follow-up and Robinson's criteria were compared in both groups. Both groups showed no significant difference. Fusion rates were 90.9% (20/22) in ACDF with the cage alone group, 95% (19/20) in ACDF with the plate fixation group (p = 0.966). Subsidence rates of ACDF with cage alone were 31.81% (7/22) and ACDF with plate fixation were 30% (6/20) (p = 0.928). Local and regional kyphotic angle difference showed no significant difference. At the final follow-up, adjacent level disease developed in 4.54% (1/22) of ACDF with cage alone and 10% (2/20) of ACDF with plate fixation (p = 0.654).CONCLUSION: In two-level ACDF, ACDF with cage alone would be comparable with ACDF with plate fixation with regard to clinical outcome and radiologic result with no significant difference. We suggest that the routine use of plate and screw in 2-level surgery may not be beneficial.KEYWORDS: ACDF ACDF Adjacen F SubsidencePMID:
[PubMed] PMCID: PMC2982913 The mean posterior neck and arm pain VAS of both groups before surgery and at the different follow-up intervals.J Korean Neurosurg Soc. ):342-346.A : Pre-operative magnetic resonance (MR) image shows disc herniation at C5-6 and C6-7. B : Pre-operative simple lateral radiograph. C : Postoperative simple lateral radiograph immediately shows ACDF, C5-6 & C6-7 with Solis cage. D : Simple lateral radiograph at two years postoperative shows fusion state without subsidence and adjacent level degeneration.J Korean Neurosurg Soc. ):342-346.A : Pre-operative magnetic resonance (MR) image shows disc herniation at C5-6 & C6-7. B : Preoperative simple lateral radiograph. C : Postoperative simple lateral radiograph immediately shows ACDF, C5-6 & C6-7 with plate fixation. D : Simple lateral radiograph at six months postoperative shows anterolisthesis at C4-5.J Korean Neurosurg Soc. ):342-346.Full Text Sources
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