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动态颈椎植入物关节成形术与前路颈椎间盘切除术和融合术治疗颈椎退行性椎间盘疾病的临床和影像学比较。

Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease.

机构信息

Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, 51 Fucheng Road, Beijing 100048, China.

Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

J Clin Neurosci. 2014 Jun;21(6):942-8. doi: 10.1016/j.jocn.2013.09.007. Epub 2013 Nov 4.

Abstract

This study compared the clinical and radiological outcomes of dynamic cervical implant (DCI; Scient'x, Villers-Bretonneux, France) arthroplasty versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. This prospective cohort study enrolled patients with single-level cervical degenerative disc disease who underwent DCI arthroplasty or ACDF between September 2009 and June 2011. Patients were followed up for more than 2years. Clinical evaluation included the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Neck Disability Index (NDI), Japan Orthopedic Association (JOA) score, and visual analog scale (VAS) scores for neck and arm pain. Radiological assessments included segmental range of motion (ROM), overall ROM (C2-C7), disc height (DHI), and changes in adjacent disc spaces. The VAS, SF-36, JOA, and NDI scores improved significantly after surgery in both the DCI and ACDF groups. The VAS, JOA, and SF-36 scores were not significantly different between the DCI and ACDF groups at the final follow-up. The segmental ROM at the treated level and overall ROM increased significantly after surgery in the DCI group, but the ROM in the adjacent cephalad and caudal segments did not change significantly. The mean DHI at the treated level was significantly restored after surgery in both groups. Five patients (12.8%) in the DCI group showed new signs of adjacent segment degeneration. These results indicate that DCI is an effective, reliable, and safe procedure for the treatment of cervical degenerative disc disease. However, there is no definitive evidence that DCI arthroplasty has better intermediate-term results than ACDF.

摘要

本研究比较了动态颈椎植入物(DCI;Scient'x,Villers-Bretonneux,法国)与前路颈椎间盘切除融合术(ACDF)治疗颈椎退行性椎间盘疾病的临床和影像学结果。这项前瞻性队列研究纳入了 2009 年 9 月至 2011 年 6 月期间接受 DCI 关节成形术或 ACDF 治疗的单节段颈椎退行性椎间盘疾病患者。患者随访时间超过 2 年。临床评估包括健康研究 36 项简短形式健康调查(SF-36)、颈部残疾指数(NDI)、日本骨科协会(JOA)评分和颈部及手臂疼痛的视觉模拟评分(VAS)。影像学评估包括节段活动范围(ROM)、总活动范围(C2-C7)、椎间盘高度(DHI)和相邻椎间盘间隙的变化。DCI 和 ACDF 组患者术后 VAS、SF-36、JOA 和 NDI 评分均显著改善。末次随访时,DCI 和 ACDF 组间 VAS、JOA 和 SF-36 评分无显著差异。DCI 组治疗节段和总活动范围术后显著增加,但相邻颅侧和尾侧节段的 ROM 无显著变化。两组治疗节段的平均 DHI 术后均显著恢复。5 例(12.8%)DCI 组出现新的相邻节段退变迹象。这些结果表明,DCI 是治疗颈椎退行性椎间盘疾病的一种有效、可靠和安全的方法。然而,目前尚无明确证据表明 DCI 关节成形术在中期结果方面优于 ACDF。

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