假体宽度和深度对颈椎间盘置换术后异位骨化的影响。

Effect of Prosthesis Width and Depth on Heterotopic Ossification After Cervical Disc Arthroplasty.

机构信息

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

出版信息

Spine (Phila Pa 1976). 2019 May 1;44(9):624-628. doi: 10.1097/BRS.0000000000002915.

DOI:10.1097/BRS.0000000000002915

PMID:30395084

Abstract

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

To investigate the effect of width and depth of the inserted cervical disc prosthesis on heterotopic ossification (HO) after cervical disc arthroplasty, and to explore the relationship between clinical outcome and HO.

SUMMARY OF BACKGROUND DATA

The mechanism of HO formation still remains unknown. Footprint mismatch of cervical disc prosthesis was common in cervical arthroplasty. Compared with endplate, some inserted prostheses were smaller in width and length.

METHODS

Retrospectively analyze the patients who underwent cervical disc arthroplasty with Prestige-LP Disc in our institute. Patients were divided into HO group or non-HO group according to the McAfee classification. The ratios of the width (Rw) and depth (Rd) of prosthesis to endplate were calculated. Radiographic and clinical assessments included: C2-7 angle, segmental angle, range of motion (ROM) of the index level, visual analogue scale, neck disability index, and Japanese orthopaedic association scores.

RESULTS

The mean follow-up time was 47.7 months. At the last follow-up, the overall incidence of HO was 34.3% (35/102). There were 35 patients in the HO-group, and 67 patients in the non-HO group. The overall Rw and Rd were 0.887 ± 0.057 and 0.927 ± 0.048, respectively. Both the Rw and Rd of HO-group were smaller than those of non-HO group (0.869 vs. 0.897, P = 0.033; 0.888 vs. 0.948, P < 0.001). There were no significant differences in visual analogue scale, neck disability index, or Japanese orthopaedic association scores, C2-7 angle, or segmental angle between the two groups. But the HO group had less ROM of the index level than the non-HO group (5.3° vs. 9.0°).

CONCLUSION

Some of prosthesis had insufficient coverage to the endplate in width and depth. Insufficient coverage of endplate in width and depth may induce the formation of HO. HO could reduce the ROM of the index level, but did not influence the clinical outcome.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性分析。

目的

探讨颈椎间盘置换术后颈椎间盘假体插入的宽度和深度对异位骨化（HO）的影响，并探讨其与临床结果的关系。

背景资料概要

HO 形成的机制仍不清楚。颈椎置换术中颈椎间盘假体的足迹不匹配很常见。与终板相比，一些插入的假体在宽度和长度上较小。

方法

回顾性分析在我院行颈椎间盘置换术的患者，使用 Prestige-LP 椎间盘。根据 McAfee 分类，患者分为 HO 组或非 HO 组。计算假体宽度（Rw）和深度（Rd）与终板的比值。影像学和临床评估包括：C2-7 角、节段角、指数水平的活动度（ROM）、视觉模拟评分、颈部残疾指数和日本矫形协会评分。

结果

平均随访时间为 47.7 个月。末次随访时，HO 的总体发生率为 34.3%（35/102）。HO 组 35 例，非 HO 组 67 例。总体 Rw 和 Rd 分别为 0.887±0.057 和 0.927±0.048。HO 组的 Rw 和 Rd 均小于非 HO 组（0.869 比 0.897，P=0.033；0.888 比 0.948，P<0.001）。两组间视觉模拟评分、颈部残疾指数或日本矫形协会评分、C2-7 角或节段角无显著差异。但 HO 组指数水平的 ROM 小于非 HO 组（5.3°比 9.0°）。