Hybrid术中融合对邻近置换节段的影响

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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

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