Bryan人工颈椎间盘置换术治疗颈椎病早中期疗效观.docVIP

　　Bryan人工颈椎间盘置换术治疗颈椎病早中期疗效观 毕业 ：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，并保持颈椎稳定和节段活动。［方法］对19例23个椎间盘的人工颈椎间盘置换术进行了随访。随诊时间：8～76个月，平均29个月。其中脊髓型颈椎病15例，其他4例。男12例，女7例；年龄35～52岁，平均40.5岁。单节段置换16例，双节段2例,3节段1例。［结果］术中或术后没有神经和血管损伤的并发症。JOA评分从平均8.6分增加到15.8分。没有假体下沉和明显偏移。置换节段稳定并部分恢复了颈椎正常的活动范围，前屈和后伸活动范围是4.68°(3.6°～6.1°)；左右侧屈的活动范围是3.51°(2.5°～4.6°)、3.42°(2.6°～4.3°)。CT和MRI随访表明2/23节段的假体偏移＜1.5 mm。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