Tian Y, Wei L X, Chen H J, Wang X W, Cao P, Liu Y, Yuan W
Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 8;100(45):3584-3589. doi: 10.3760/cma.j.cn112137-20200715-02127.
To analyze the incidence of heterotopic ossification after artificial cervical disc replacement with Discover disc, and to explore the effect of heterotopic ossification on postoperative radiological and clinical efficacy. From January 2010 to January 2015, 45 patients with cervical spondylosis underwent single-level artificial cervical disc replacement in Shanghai Changzheng Hospital, including 29 cases of cervical spondylotic myelopathy, 11 cases of cervical spondylotic radiculopathy and 5 cases of mixed cervical spondylosis. At the last follow-up, Mehren grading method was used for classification of heterotopic ossification, among which, grade 0-Ⅱ was defined as low grade ossification group, and 26 patients (16 male, 10 female) were enrolled in this group; grade Ⅲ-Ⅳ was defined as high grade ossification group, and 19 patients (12 males, 7 females) were included in this group. C(2-7) Cobb angle, cervical total range of motion and range of motion at index level were used to evaluate the radiological outcomes of the two groups. Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score and visual analogue scale (VAS) were used to evaluate the clinical outcomes of the two groups. The adjacent segment intervertebral disc height and range of motion were used to evaluate the effects of heterotopic ossification on adjacent segment. All patients were followed up regularly for (98±18) months. There were no statistical differences between the two groups regarding to demographic data (all 0.05). There was no significant differences in C(2-7) Cobb angle and total range of motion between the two groups at the last follow-up (all 0.05), but range of motion at index level in the group with low grades was significantly higher than that in the group with high grades (7.8°±6.2° vs 2.6°±1.2°, 3.60, 0.05). There was no significant differences in JOA score, recovery rate and NDI score between the two groups (all 0.05). There was no significant differences in the adjacent segment intervertebral disc height before operation and at the last follow-up (both 0.05). There was no significant differences in range of motion at adjacent segment before operation (0.05), while range of motion at adjacent segment in the group with low grades was significantly lower than that in the group with high grades (9.5°±1.1° vs 10.6°±1.8° and 9.4°±1.4° vs 10.5°±1.7°, repectively, 2.54, 2.31, both 0.05). Heterotopic ossification does not affect the clinical outcomes, cervical curvature and cervical total range of motion after artificial cervical disc replacement with Discover disc. However, the higher grade of heterotopic ossification, the lower range of motion at index level and the higher range of motion at adjacent segment.
分析采用Discover椎间盘行人工颈椎间盘置换术后异位骨化的发生率，并探讨异位骨化对术后影像学及临床疗效的影响。2010年1月至2015年1月，上海长征医院45例颈椎病患者接受单节段人工颈椎间盘置换术，其中脊髓型颈椎病29例，神经根型颈椎病11例，混合型颈椎病5例。末次随访时，采用Mehren分级法对异位骨化进行分类，其中0 - Ⅱ级定义为低级别骨化组，该组纳入26例患者（男16例，女10例）；Ⅲ - Ⅳ级定义为高级别骨化组，该组纳入19例患者（男12例，女7例）。采用C(2 - 7) Cobb角、颈椎总活动度及责任节段活动度评估两组的影像学结果。采用日本骨科学会（JOA）评分、颈部功能障碍指数（NDI）评分及视觉模拟量表（VAS）评估两组的临床结果。采用相邻节段椎间盘高度及活动度评估异位骨化对相邻节段的影响。所有患者均定期随访（98±18）个月。两组患者的人口统计学数据比较差异无统计学意义（均P>0.05）。末次随访时，两组患者的C(2 - 7) Cobb角及总活动度比较差异无统计学意义（均P>0.05），但低级别组责任节段活动度显著高于高级别组（7.8°±6.2° vs 2.6°±1.2°，t = 3.60，P<0.05）。两组患者的JOA评分、恢复率及NDI评分比较差异无统计学意义（均P>0.05）。术前及末次随访时相邻节段椎间盘高度比较差异无统计学意义（均P>0.05）。术前相邻节段活动度比较差异无统计学意义（P>0.05），而低级别组相邻节段活动度显著低于高级别组（分别为9.5°±1.1° vs 10.6°±1.8°和9.4°±1.4° vs 10.5°±1.7°，t分别为2.54、2.31，均P<0.05）。采用Discover椎间盘行人工颈椎间盘置换术后，异位骨化不影响临床疗效、颈椎曲度及颈椎总活动度。然而，异位骨化级别越高，责任节段活动度越低，相邻节段活动度越高。
