Bryan人工颈椎间盘置换术治疗颈椎病早中期疗效观察论文.docVIP

　　Bryan人工颈椎间盘置换术治疗颈椎病早中期疗效观察论文 杨述华，李进，刘国辉，许伟华，杨操，叶树楠，胡勇 【摘要】 ［目的］探讨Bryan人工颈椎间盘置换术缓解颈椎病神经症状和体征，提高患者的生活质量.freelm。颈椎的生理弧度没有明显的丢失。置换节段假体周围没有骨化。［结论］19例人工颈椎间盘置换术取得了满意的近期疗效。与颈椎前路椎间盘摘除植骨融合术最大的不同点是患者恢复快，没有颈椎活动受限的缺陷。但至少需要5年的长期随访来评价假体的功能和对邻近节段的影响。 【关键词】 人工颈椎假体； 人工颈椎间盘； 颈椎间盘突出症； 退行性颈椎间盘疾病 Abstract：［Objective］To determine objective neurologic symptoms and signs,improve the patients ability to perform activities of daily living,decrease pain,and maintain stability and segmental motion.［Method］Nine cases ent December 2003 to October 2004.The folloe ranged from 8 to 76 months,averge 29 months.There yelopathy in 4 cases.Cervical disc herniation ales 7 cases.Age from 35 to 52 years old,averge 40.5 years.Single-level 16 cases,bi-level 2 cases,three level 1 case.［Result］No neurological or vascular plication averaged 8.6 to 15.8.There ent achived stability and restored partial of normal ROM,4.68°(3.6°～6.1°)in flextion and extension position and 3.51°(2.5°～4.6°),3.42°(2.6°～4.3°)in left and right bending position.No obvious loss of lordosis m)in 2/23 levels;and no ossification in the replaced levels.［Conclusion］It is a good early oute for 19 cases artifical disc replacement.Discectomy and implantation of the device alleviates neurologic symptoms and signs similar to anterior cervical discectomy and fusion.Radiographic evidence supports maintenance of motion.The procedure is safe and the patients recover quickly.At least 5 years of follo function of the prosthesis and protective influence on adjacent levels. Key m、15 mm、16 mm、17 mm和18 mm 5种型号。 1.2 手术技巧 （以C5、6节段为例）：（1）患者仰卧位，肩部垫软枕，颈部稍后伸。C型臂X线机透视确定C5椎体后上角与C6椎体后下角的连线与量角标尺上垂直线的夹角度数（C5、6椎间隙与垂线的夹角度数）。（2）椎间盘暴露于右侧颈前相当于C5、6间隙为中心行纵形切口，切开皮肤、皮下及颈阔肌。仔细止血后分别向上、下游离颈阔肌皮瓣，并暴露出胸锁乳突肌。沿胸锁乳突肌内侧缘分别向上、下行锐分离，找到血管鞘并用手指保护之。用条状剥离子钝性分离达颈前筋膜，将气管牵拉到左侧，锐性分离椎前筋膜。C型臂X线机透视证实为目标椎间隙。安装牵引支架并与手术台固定或2个Hohmann牵开器，安放颈长肌拉钩和切口上、下端拉钩并与牵引支架固定。（3）用小刀和刮匙切除前纤维环、髓核组织和软骨板至两侧钩突。用球形磨钻去除相邻终板前缘的骨赘。手枪式椎板咬骨钳切除部分C5椎体前下缘。（4）用椎间撑开棒逐级撑开椎间隙至8.5 mm高度。用横向中点定位仪在C5椎体前缘确定横向中点并标记。将矢状位楔行定位器的弧面中心对准C