Hybrid术中融合对邻近置换节段的影响

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摘要目的研究与单节段颈椎间盘置换(cervical disc replacement，CDR)相比，Hybrid手术中融合对邻近人工间盘动力学及并发症的影响。方法回顾分析2012年3月至2015年9月在本院接受单节段CDR或单节段CDR+融合的Hybrid手术治疗，并完成至少4年随访的68例患者资料。单节段CDR组42例，男16例，女26例；年龄27～63岁，平均(43.69±7.27)岁。Hybrid组26例，男11例，女15例；年龄35～57岁，平均(47.04±6.26)岁。分别于术前和术后各随访时间点评估患者影像学和临床功能指标，包括置换节段曲度和其变化、置换节段及其邻近节段活动度(range of motion，ROM)、假体前后移位和下沉、异位骨化、置换节段的相邻节段退变以及临床功能评分。比较两组间相关评估指标的差异及组内相关指标手术前后的差异。结果尽管两组在末次随访时均能维持置换节段术前的局部曲度(P＞0.05)，但与单节段CDR组相比，Hybrid组术后即刻增加的节段前凸在末次随访时更易丢失(P＜0.05)；Hybrid组并没有呈现出间盘假体的高活动度，也能在末次随访时维持假体邻近节段的术前ROM(P＞0.05)；Hybrid组假体平均下沉和前后移位的量更大，特别是移位方面差异有统计学意义(P＜0.05)，但是两组间在明显下沉和移位的病例数量上差异无统计学意义(P＞0.05)；Hybrid组异位骨化和邻近节段退变的发生率较高，但差异无统计学意义(P＞0.05)。两组在术后临床功能评分上均较术前明显改善(P＜0.05)，但两组间比较差异无统计学意义(P＞0.05)。结论与单节段CDR相比，尽管Hybrid术中融合节段影响了其相邻人工椎间盘的部分动力学表现，但并没有明显增加假体并发症和引起不良临床效果。

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关键词 ：颈椎间盘置换, Hybrid手术, 假体动力学, 并发症

Abstract：Objective To study the effect of the fused level on the prosthetic dynamics and complications in hybrid surgery compared with single-levelcervical disc replacement (CDR).Methods Between March 2012 and September 2015，patients undergoing either a 1-level CDR or hybrid surgery(1-level CDR+fusion) wereretrospectively reviewed.All patients were followed up clinically and radiographically for a minimum of 4 years.The patients in the 1-level CDR group included 16 men and 26 women，with a mean age of (43.69±7.27)years (27~63).The patients in the hybrid group included 11 men and 15 women，with a mean age of (47.04±6.26)years (35~57).Radiologicalparameters and clinical outcome scores were evaluated at preoperative and postoperative follow-up points，includingsegmental alignmentand its changes，range of motion (ROM) of the disc replacement and its adjacent segments，migration and subsidence of the prosthesis，heterotopic ossification (HO)，adjacent segment degeneration (ASD) adjacent to the arthroplasty level，andclinical outcome scores.Results Compared to the 1-level CDR group，the increased segmental lordosis immediately after surgery in the hybridgroup was more likely to be lost throughout the follow-up period(P＜0.05)，although both groups generally maintainedthe preoperative segmental alignment of the arthroplasty segment postoperatively(P＞0.05)；thehybridgroup did not exhibithypermobility of the disc prosthesis and preserved the preoperative ROM of theadjacent segment of the device(P＞0.05)；The mean amount of subsidence and migrationof the prosthesis in the hybridgroup was relatively larger，especially the difference in prosthesis migration was significant(P＜0.05)，but there was no significant difference in the number of cases of obvious migration or subsidence between the groups(P＞0.05)；the incidence rates of HO and ASD in the hybridgroup were higher，but there were no significant differences(P＞0.05).The clinical outcome scores of the two groups at the final follow-up were significantly improved compared with that of preoperative(P＜0.05)，and there were no significant differences between two groups(P＞0.05).Conclusion the fused level in the hybridgroup partially affected the dynamicperformance compared to single-level CDR，it did not increase prosthesis-related complications and causeadverse clinical outcomes.

Key words： cervical disc replacement hybrid surgery prosthetic dynamics complications

基金资助:国家自然科学基金面上项目(81572141)
四川大学华西医院临床研究孵化项目(2019HXFH040)
川北医学院校级科研发展计划项目(CBY17-A-ZD04)

作者简介: 胡凌云(1983－ )，男，副主任医师，四川大学华西医院骨科，610041。

引用本文:

胡凌云 1，2，吴廷奎 1，刘浩 1*，杨毅 1，孟阳 1，王贝宇 1，丁琛 1. Hybrid术中融合对邻近置换节段的影响[J]. 实用骨科杂志, 2020, 26(8): 676-687.
Hu Lingyun 1，2，Wu Tingkui 1，Liu Hao 1，et al. Effect of the Fused Level on Adjacent Disc Prosthesis in Hybridsurgery. sygkzz, 2020, 26(8): 676-687.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I8/676

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