颈椎间盘置换联合颈前路融合手术治疗三节段颈椎病的临床疗效分析

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目的初步评估Prestige LP人工椎间盘置换联合Zero-P零切迹椎间融合固定器植骨融合治疗三节段颈椎病的安全性和有效性。方法回顾分析2012年9月到2015年4月在我院行Prestige LP人工椎间盘置换联合Zero-P零切迹椎间融合固定器植骨融合的三节段颈椎病患者的临床和影像学资料，采用视觉模拟评分(visual analogue scale，VAS)、日本骨科协会(Japanese orthopaedic association，JOA)脊髓功能评分及颈椎残障功能指数(neck disability index，NDI)评估患者术后临床疗效；行颈椎X线正侧位、过伸过屈位、左右侧偏位和CT三维重建检查观察患者术后假体的位置和稳定性、置换节段活动度和异位骨化情况、融合节段植骨融合情况。结果共纳入患者24例，9例患者行单节段置换＋双节段融合术，其余15例行双节段置换＋单节段融合术，共植入39枚Prestige LP人工椎间盘假体和33枚Zero-P零切迹椎间融合固定器。患者VAS评分、JOA评分和NDI指数在术后历次随访较术前均有明显改善(P＜0.05)，置换节段活动度较术前无明显差异(P＞0.05)，颈椎整体活动度较术前有明显下降(P＜0.05)。结论 Prestige LP人工椎间盘置换联合零切迹椎间融合固定器Zero-P植骨融合的三节段Hybrid手术是一种安全的可以选择的治疗多节段颈椎病的手术方式，可以有效缓解患者临床症状，最大限度保留患者颈椎节段活动度，降低植骨不融合风险和邻近节段椎间盘的应力。

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关键词 ：杂交手术, 椎间盘置换术, 颈椎前路减压融合术, 颈椎病

Abstract：Objective To evaluate the effectiveness and safety of Prestige LP cervical disc replacement combined with Zero-Profile implant system interbody fusion intreating three-level cervical spondylosis.Methods Patients who underwent three-level hybrid surgery using Prestige LP and Zero-P between September 2012 and April 2015 were retrospectively analyzed，clinical and radiologic data were collected.The visual analogue score (VAS)，Japan Orthopedic Association (JOA) score and neck disability index (NDI) were used to evaluate the clinical effect after surgery；cervical X-Rays and three-dimensional reconstruction CT scan were used to assess the postoperative prosthesis position and stability，the replacement segment activity and heterotopic ossification，and fusion rate in fusion segments.Results 24 cases were included in this study，9 patients underwent single level disc replacement+two-level interbody fusion，15 patietns underwent double-level disc replacement+single level interbodyfusion.39 Prestige LP artificial disc prosthesis and 33 Zero-P zero profile impalnts were impalnted at last.The VAS score，JOA score and NDI index at the final follow-up were significantly improved compared with that pre operation (P＜0.05)，no significant difference was found concerning the replacement segment range of motion between the final follow-up and preoperative (P＞0.05)，the overall cervical range of motion decreased significantlycompared with preoperative (P＜0.05).Conclusion Hybrid surgery of Prestige LP cervical disc replacement combined with Zero-Profile interbody fusion may be a safe and effective option for the treatment of three-level cervical spondylosis.It can effectively relief the clinical symptoms，maintain cervical segmental range of motion，reduce therisk of nonfusionand decrease the adjacent segmental intervertebral disc stress.

Key words： hybrid surgery cervical disc replacement anterior cervical discectomy and fusion cervical spondylosis

通讯作者: 刘浩

作者简介: 杨毅(1990－ )，男，医师，四川大学华西医院骨科，610041

引用本文:

杨毅 1，曾俊峰 1，刘浩 1*，洪瑛 2，龚全 1，马立泰 1，王贝宇 1，丁琛 1，邓宇骁 1. 颈椎间盘置换联合颈前路融合手术治疗三节段颈椎病的临床疗效分析[J]. 实用骨科杂志, 2017, 23(3): 193-197.
Yang Yi，Zeng Junfeng，Liu Hao，et al. Clinical Results of Hybrid Surgery of Cervical Disc Replacement Combined with Fusion in Treating Three-level Cervical Spondylosis. sygkzz, 2017, 23(3): 193-197.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I3/193

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