Wu T K, Liu H, Wang B Y, Meng Y, Ding C, Rong X, Chen H, Yang Y, Hong Y, Huang K K, He J B
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
West China School of Nursing, Sichuan University/Department of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 8;100(45):3596-3601. doi: 10.3760/cma.j.cn112137-20200610-01813.
To investigate the effects of preoperative segmental range of motion (ROM) on clinical and radiographical outcomes after artificial cervical disc replacement (ACDR) and explore whether ACDR could be indicated for patients with preoperative limited or excessive segmental ROM. From January 2008 to December 2017, patients who underwent Prestige-LP ACDR in West China Hospital were retrospectively reviewed. The preoperative and postoperative X-rays of the cervical spine were collected to measure the radiographic parameters, including cervical lordosis (CL), C(2-7) ROM, disc height (DH), disc angle (DA) and ROM at the arthroplasty level. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) and the Neck Disability Index (NDI) scores. The correlation between preoperative segmental ROM and postoperative clinical and radiographical outcomes were also analyzed. A total of 161 patients were analyzed, with 73 males and 88 females. The mean age was (44±8) years, and the follow-up period was 34 months (12-120 months). JOA and NDI scores improved after ACDR (0.05). However, postoperative C(2-7) ROM and ROM at the arthroplasty level were comparable with preoperative counterparts (both 0.05). Preoperative segmental ROM positively correlated with C(2-7) ROM and ROM at the arthroplasty segment (0.213、0.271, both 0.05), but was negatively correlated with the change of ROM (-0.534, 0.05). The segmental ROM was 4.0°±1.0° in the limited-ROM group (A) and 14.6°±1.3° in the excessive-ROM group (B), respectively. There were significantly more patients diagnosed with cervical spondylosis in group A than in group B (35.5% vs 10.7%, 0.05). The level-distribution was statistically different between the two groups. C(5/6) and C(6/7) were prone to limited motion in group A, while C(4/5) and C(5/6) were predisposed to excessive motion in group B (all 0.05). After surgery, C(2-7) ROM increased for 14.2°±16.8° in group A, while paradoxically decreased for 2.2°±14.4° in group B. However, C(2-7) ROM in group B was still larger than that in group A (0.05). Similarly, the ROM at the arthroplasty level increased by 3.1°±3.7° in group A, whereas the values decreased by 4.4°±4.2° in group B postoperatively. In addition, group A still had less segmental ROM than group B (0.05). The preoperative DH in group A was less than that in group B (0.05). The rates of ASD, HO, and high-grade HO in group A were all higher than those in group B but without significant differences (all 0.05). Preoperative segmental ROM has no significant effects on clinical outcomes after ACDR; it has a positive correlation with postoperative global and segmental ROM while is negatively correlated with ROM change.
探讨术前节段活动度（ROM）对人工颈椎间盘置换术（ACDR）后临床及影像学结果的影响，并探究ACDR是否适用于术前节段ROM受限或过度的患者。回顾性分析2008年1月至2017年12月在四川大学华西医院接受Prestige-LP ACDR的患者。收集颈椎术前和术后X线片以测量影像学参数，包括颈椎前凸（CL）、C（2-7）ROM、椎间盘高度（DH）、椎间盘角度（DA）及置换节段的ROM。采用日本骨科协会（JOA）评分和颈部功能障碍指数（NDI）评估临床结果。分析术前节段ROM与术后临床及影像学结果之间的相关性。共分析161例患者，其中男性73例，女性88例。平均年龄（44±8）岁，随访时间34个月（12-120个月）。ACDR术后JOA和NDI评分改善（均P<0.05）。然而，术后C（2-7）ROM及置换节段的ROM与术前相当（均P>0.05）。术前节段ROM与C（2-7）ROM及置换节段的ROM呈正相关（分别为0.213、0.271，均P<0.05），但与ROM变化呈负相关（-0.534，P<0.05）。ROM受限组（A组）节段ROM为4.0°±1.0°，ROM过度组（B组）为14.6°±1.3°。A组诊断为颈椎病的患者明显多于B组（35.5%对10.7%，P<0.05）。两组节段分布有统计学差异。A组C（5/6）和C（6/7）节段易出现活动受限，而B组C（4/5）和C（5/6）节段易出现活动过度（均P<0.05）。术后，A组C（2-7）ROM增加14.2°±16.8°，而B组反而减少2.2°±14.4°。然而，B组C（2-7）ROM仍大于A组（P<0.05）。同样，A组置换节段的ROM术后增加3.1°±3.7°，而B组术后减少4.4°±4.2°。此外，A组节段ROM仍低于B组（P<0.05）。A组术前DH低于B组（P<0.05）。A组邻椎病、异位骨化及高级别异位骨化的发生率均高于B组，但差异无统计学意义（均P>0.05）。术前节段ROM对ACDR术后临床结果无显著影响；其与术后整体及节段ROM呈正相关，而与ROM变化呈负相关。
