知识与财富的链接
背景：颈椎人工间盘置换术作为一种新的技术,近年来在脊柱外科领域广泛应用。它具有保留手术节段活动,保留置换节段的生物力学环境,减少临近节段退变等优点。尽管颈椎人工间盘置换的短期临床效果已经得到了肯定,但是中期的临床效果尚缺乏报道。 材料与方法：对2003年12月到2006年1月行颈椎人工间盘置换术的50例患者进行了随访。其中单节段颈椎人工间盘置换39例,双节段颈椎人工间盘置换11例。随访时年龄29-73岁（平均年龄50.9岁）。随访时间36.0-55.63个月,呈偏态分布,中位数为41.85个月,四分位数间距为8.71个月。。记录患者症状、神经系统体征及影像学情况。 结果：JOA评分中位数术前为14.0,末次随访时为16.5,两者间差异有统计学意义（P<0.01）,JOA评分改善率中位数为92.17%。末次随访置换节段过屈过伸活动度8.56°±4.76°与术前置换节段过屈过伸活动度10.4°±4.97°呈正相关并有统计学意义（P<0.05,r=0.33）。末次随访时置换节段活动度与术后三个月7.52°±3.37°相比略有增加,并有统计学意义（P<0.05）。术前中立位置换节段的曲度-0.96°±6.52°与末次随访时中立位置换节段的曲度-2.65°±7.95°有相关性（r=0.53,P<0.01）,差异无统计学意义（P>0.05）。术前中立位置换节段的终板间夹角为2.61°±4.85°与末次随访时置换节段的中立位假体终板间夹角0.71°±6.41°无相关性,差异无统计学意义（P>0.05）。 结论：Bryan人工间盘置换术3年随访的疗效是满意的,颈椎置换节段的生理运动范围及生物力学环境得到了较好的保持。
Background: Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. Although the clinical and radiographic effects of cervical disc arthroplasty in short-term have been ascertained, data of mid-term results are lacking. Methods: In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years (range, 29 to 73). The median follow-up was 41.85 months (range, 36.0-55.63 months. Patients were followed prospectively with respect to their symptoms, neurologic signs, and radiographic results. Results: The median value of Japanese Orthopaedic Association (JOA) score was 14.0 before surgery, and 16.5 at the most recent follow-up (P<0.01). The median value of the recovery rate of the JOA score was 92.17%. The preoperative range of movement (ROM) at the indexed level was 10.4±4.97°, which has significantly correlated with the most recent follow-up ROM which was 8.56±4.76° (P<0.05, r=0.33). The ROM at the operative level at the most recent follow-up was greater than the value at the 3-month follow-up of 7.52±3.37° (P<0.05). The preoperative functional spinal unit (FSU) angulation was -0.96±6.52°, which was significantly correlated with, but not significantly different with that of the most recent follow-up value of -2.65±7.95°(P<0.01, r=0.53). The preoperative endplate angulation was 2.61±4.85°, which had no significant correlation and no significant difference with that of the most recent follow-up value of 0.71±6.41° (P>0.05). Conclusions: The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.