颈椎人工椎间盘置换术中椎旁骨化的产生与发展：使用冠状面重建CT的详细分析报告

Generation and Development of Paravertebral Ossification in Cervical Artificial Disk Replacement: A Detailed Analytic Report Using Coronal Reconstruction CT.

作者信息

Tian Wei, Han Xiao, Liu Bo, He Da, Lv Yanwei, Yue James

机构信息

*Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China †Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.

出版信息

Clin Spine Surg. 2017 Apr;30(3):E179-E188. doi: 10.1097/BSD.0000000000000044.

DOI:10.1097/BSD.0000000000000044

PMID:28323697

Abstract

STUDY DESIGN

A retrospective follow-up study and review of images in published papers.

OBJECTIVE

To determine whether true heterotopic ossification (HO) occurs in artificial disk replacement (ADR); to evaluate the incidence of paravertebral ossification (PO) and its influence on ADR.

SUMMARY OF BACKGROUND DATA

HO is typically defined as the abnormal formation of true bone within extraskeletal soft tissues. However, HO in ADR does not fit this definition precisely, as it originates from vertebral body, making it hard to distinguish radiologically from preexisting osteophytes. In this study, the term used for bone formation around ADR is PO.

METHODS

First, all images in the published papers were evaluated as to whether the presented PO in ADR fit the classic definition of HO or osteophytes. Second, we studied 37 consecutive patients who underwent ADR and follow-up for minimum 24 months. The preoperative and follow-up incidence of PO and its influence on range of motion were evaluated using x-ray and computed tomography.

RESULTS

All 52 images of PO were found adjacent to the disk in 1 segment rather than entire cervical spine. Fifty (96.2%) of the POs were found to originate from the vertebral body rather than in the soft tissue. A total of 31 patients were included in the follow-up study. No significant difference was found in the incidence of PO between the follow-up and preoperation (61.29% vs. 48.39%, P>0.05). The range of motion of the ADR segment in patients with progressed PO (7.44±4.64 degrees) was significantly lower than that of patients with stable PO grade (12.13±4.42 degrees, P<0.01) at last follow-up.

CONCLUSIONS

A proportion of HO might in fact be the natural development of preoperative osteophytes, which is unrelated to ADR; the remaining HO might be due to changes in biomechanical environment after surgery, which promotes the grade of osteophytes and affects the segment motion.

摘要

研究设计

一项回顾性随访研究及对已发表论文中图像的回顾。

目的

确定人工椎间盘置换术（ADR）中是否发生真性异位骨化（HO）；评估椎旁骨化（PO）的发生率及其对ADR的影响。

背景数据总结

HO通常被定义为骨骼外软组织内真性骨的异常形成。然而，ADR中的HO并不完全符合这一定义，因为它起源于椎体，在放射学上很难与先前存在的骨赘区分开来。在本研究中，ADR周围骨形成所用的术语为PO。

方法

首先，评估已发表论文中的所有图像，以确定ADR中呈现的PO是否符合HO或骨赘的经典定义。其次，我们研究了37例连续接受ADR并至少随访24个月的患者。使用X射线和计算机断层扫描评估PO的术前和随访发生率及其对活动范围的影响。

结果

在1个节段而非整个颈椎中发现所有52张PO图像均与椎间盘相邻。发现50例（96.2%）PO起源于椎体而非软组织。共有31例患者纳入随访研究。随访时与术前PO的发生率无显著差异（61.29%对48.39%，P>0.05）。在最后随访时，PO进展患者的ADR节段活动范围（7.44±4.64度）明显低于PO分级稳定患者（12.13±4.42度，P<0.01）。