【摘要】 目的 探讨经皮脊柱后凸成形手术中骨水泥的应用疗效。 方法 2008年10月-2010年10月，应用注射用Ⅲ型丙烯酸树脂骨水泥及其椎体成形系统，采取经皮脊柱后凸成形术治疗40例椎体疾病患者。其中男5例，女35例；年龄53～84岁，平均65岁。老年骨质疏松性椎体压缩骨折37例，椎体恶性肿瘤2例，椎体血管瘤1例。采用视觉模拟评分（visual analogue scale，VAS）对患者手术前后疼痛程度的改善情况进行评分统计，并观察术中及术后并发症的发生情况。 结果 患者出院前行脊柱正、侧位透视，发现椎体内骨水泥分布良好；3例有少量骨水泥向椎体外渗漏现象，但均无临床症状。所有患者获随访1～12个月，平均8个月。腰背部疼痛均明显缓解或消失，日常生活质量大大提高。术前VAS评分为（8.30±0.48）分，术后3 d、1个月及末次随访时VAS评分分别为（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，与术前比较差异均有统计学意义（Plt;0.05）。 结论 骨水泥应用于经皮脊柱后凸成形手术中可取得很好疗效，固化的骨水泥对脊柱起到很好的支撑、稳定作用。【Abstract】 Objective To assess the clinical effect of using bone cement in percutaneous kyphoplasty. Methods From October 2008 to October 2010, type Ⅲ Acrylic resin bone cement and the system of vertebroplasty were used in percutaneous kyphoplasty (PKP) to treat 40 patients. There were 5 males and 35 females with an average of 65 years old (53-84 years). There were 37 older patients with osteoporotic vertebral compression fracture, 2 cases of vertebral tumor and one hemangioma. Visual analogue scale (VAS) was used to evaluate the pain before and after the operation. The complications in and after the operation were also recorded. Results Before discharge, posterior-anterior and lateral X-ray films were taken to evaluate the distribution of bone cement. Three patients showed a little bone cement leakage from the vertebral body, but no clinical symptoms were found. All patients were followed for 1 to 12 months with an average of 8 months. Pain in the back decreased obviously or disappeared, and the qualities of daily life were improved greatly. The score of VAS was (8.30±0.48) before the operation, and (3.11±0.41), (2.50±0.36), and (2.50±0.36) 3 days, 1 month after the operation, and during the last follow-up, respectively. Significant differences were found between the VAS score before and after operation (Plt;0.05). Conclusions Good results can be expected when bone cement is used in percutaneous kyphoplasty. Solidified bone cement can effectively support and stablize the spinal column.
Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P lt; 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t= — 0.391, P=0.698), and between the targeted disc and the cervical alignment (t= — 1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t= — 2.623, P=0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P lt; 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.
Objective There is few report on dynamic stabil ization for posterior cervical reconstruction. To investigate the biomechanical properties of a novel cervical spine posterior fixation using the bio-derived freeze-dried tendon in posterior cervical spine reconstruction. Methods The palmaris longus flexor tendon and metacarpal extensor tendon were collected from the death donors’ stump to prepare bio-derived tendon. Twenty fresh cervical vertebrae (C1-7) were harvested from goats and were randomly divided into 4 groups (n=5): intact group (group A); injury control group (group B); screwrods fixation group, fixed with screw-rods on C3，4 (group C); tendon reconstruction group, cross-fixed with bio-derived freezedried tendon on C3，4 bilatera facet joints (group D). The range of motion (ROM) values in flexion, extension, lateral bending, and axial rotation were measured. Results In flexion, the ROM values of group C were significantly lower than those of the other 3 groups (P lt; 0.05), and the ROM values of group B were significantly higher than those of groups A and D (P lt; 0.05). In extension, lateral bending, and axial rotation, the ROM values of group C were significantly lower than those of groups A, B, and D (P lt; 0.05), and no significant difference was found within the other 3 groups (P gt; 0.05). Conclusion The novel cervical spine posterior fixation using the bio-derived frozen-dried tendon can provide enough stabil ity in flexion motion, but it can not limit the lateral bending and axial rotation motion, which can provide dynamic stabil ization in animal model.
Objective To review the l iterature about the multiple level artificial disc replacement and investigate the prel iminary the cl inical outcome of the first case in China applying three-level PRESTIGE® LP artificial disc replacement for cervical disc degenerative disease. Methods In April 2009, one female patient aged 44 years old was treated. She was diagnosed as disc protrusion at the C4, 5, C5, 6, and C6, 7 level. She had paresthesia, decreased muscle strength and positivepathological reflex in her left upper extremity. The neck disabil ity index (NDI) was 43. The visual analogue scale (VAS) of the neck and the upper l imb was 6.6 and 8.1, respectively. SF-36 physical and psychological score was 28 and 36, respectively. The surgery was performed via routine anterior cervical approach. After complete decompression of three segments, prostheses were implanted from the cephal ic to the caudal end under radiographic monitoring. The patient was followed up 1 and 3 months after operation, respectively. Results The time of operation was 220 minutes and the blood loss during operation was 270 mL. The incision healed by first intention. There was no occurrence of compl ications such as aggravation of nerve symptoms, hoarse voice, difficult in swallow, and cerebrospinal fluid leakage. At 3 months after the operation, the patient had pain rel ief, muscle force recovery and improvement of l ife qual ity. X-ray films showed that the sequence of cervical vertebra was well-maintained, there was no loosening and displacement of prosthesis, and the position and function were good. NDI was decreased to 7, indicating that the l imitation was mild. The VAS of the neck and the upper l imb was 0.5 and 0.6, respectively. SF-36 physical and psychological score was 48 and 53, respectively. The result of operation was graded as excellent according to Odom’s criterion. The patient went back to her job. Conclusion Three-level PRESTIGE® LP artificial disc replacement for cervical disc degenerative disease has satisfactory prel iminary cl inical results. However, more cl inical case studies and longer cl inical followup are needed to confirm its therapeutic effect on multi-level disc disease.
【摘要】 目的 评价Bryan人工椎间盘单节段置换治疗颈椎间盘退变性疾病的临床疗效。 方法 2004年11月—2008年4月，21例颈椎间盘退变突出并经保守治疗无效的患者接受Bryan人工颈椎间盘单节段置换术。患者术前、术后1、6、12、18、24个月时使用颈椎功能障碍指数（neck disable index，NDI）、症状程度主观评价、疼痛视觉模拟疼痛量表（visual analogue scale，VAS）进行疗效评估，手术效果使用Odom法评价。影像学检查包括颈椎功能位X线片、颈椎CT及MRI检查。 结果 21例患者均顺利完成椎间盘置换手术，术后随访2年。患者对症状的主观评分，颈痛VAS评分、手臂疼痛VAS评分，NDI分别由术前的（2.80±0.42）、（4.62±1.84）、（5.01±1.79）、（22.60±4.88）分下降到随访终止时的（0.20±0.42）、（1.01±0.56）、（0.82±0.24）、（4.30±1.25）分。所有患者对手术效果Odom 评级优良，8例（38.1%）自觉症状完全缓解。手术过程平均时间为（110.5±42.6） min，术中出血量平均为（166.0±108.8） mL。影像学评价见植入的人工椎间盘运动功能良好，未见颈椎不稳的表现。2例假体在术后早期轻度前移。 结论 Bryan人工椎间盘单节段置换是治疗颈椎间盘退变性疾病的一种安全有效的方法，术后随访2年临床疗效满意。【Abstract】 Objective To evaluate the clinical therapeutic effect of single segment Bryan disc replacement on cervical disc degenerative diseases. Methods From November 2004 to April 2008, 21 patients who had a poor response after conservative treatment for their cervical disc degeneration underwent the single level Bryan disc replacement. Before the operation and 1, 6, 12, 18, and 24 months after the operation, all patients were evaluated by neck disable index (NDI), subjective symptom scale, visual analogue scale (VAS) and Odom score. The radiological examinations included X-ray, CT scan and MRI. Results Operations were successfully executed in 21 patients. All patients had obeyed the follow-up visiting at the expected time in the next two years after the operation. Patients′ symptom scale, VAS for neck pain, VAS for arm pain, NDI were 2.80±0.42, 4.62±1.84, 5.01±1.79, and 22.60±4.88, respectively before the operation and significantly decreased to 0.20±0.42, 1.01±0.56, 0.82±0.24, and 4.30±1.25, respectively at the end of the follow-up. All patients had good or higher score of the Odom score. The ymptoms were completely relieved in eight patients (38.1%). The mean operation time was (110.5±42.6) minutes, the average blood loss was (166.0±108.8) mL. The normal motion of the artificial disc was observed. No cervical instability was observed. Two prosthesis migrated slightly. Conclusion Single segmental Bryan disc replacement is safe and effective on the cervical disc degeneration. The two-year follow-up reveales a satisfied clinical outcome.
Objective To observe the early effectiveness of cervical disc replacement with Pretic-I, a new type artificial disc. Methods A retrospective analysis was made on the clinical data of 10 patients who underwent single segmental cervical disc replacement with Pretic-I from June to December 2014. Among 10 patients, 4 were male and 6 were female, with an average age of 40 years (range, 27-51 years). The mean disease duration was 15.4 months (range, 4-36 months). Affected segments located at C4, 5 level in 1 case, at C5, 6 level in 8 cases, and at C6, 7 level in 1 case. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used to evaluate the clinical outcomes. Besides, the disc height and the range of motion (ROM) at operated level, and ROM of upper and lower adjacent level were measured to assess the function. Results The operation was successfully completed in all patients who were followed up for 12 months. No complications of aggravated nerve symptoms, vertebral artery injury, esophagotracheal fistula, cerebrospinal fluid leakage, incision infection, hematoma and prosthetic loosening were observed during follow-up. The VAS score, JOA score, and NDI significantly improved at each time point after operation when compared with preoperative scores (P<0.05). The height of intervertebral disc at operated level was significantly increased at immediate and 3 months after operation when compared with preoperative one (P<0.05), but no significant difference was found between at 6 months or 12 months after operation and at pre-operation (P>0.05). No significant difference was shown in the ROM at operated level, and ROM of upper and lower adjacent level between at pre-operation and at each time point after operation (P>0.05). Conclusion The early effctiveness of cervical disc replacement using Pretic-I is satisfactory. The symptoms can be relieved significantly and the dynamic features of the operated level, as well as the upper and lower adjacent levels, are well preserved.
ObjectiveTo assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C2 (O-C2) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion.MethodsThe clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C2 angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C2 angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C2 angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C2 angle, and lower cervical curvature (Cobb angle).ResultsAll 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones (t=15.870, P=0.000; t=6.587, P=0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C2 angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones (P<0.05); but no significant difference was found in POCA and O-C2 angles between at 3 days after operation and at last follow-up (P>0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation (P>0.05).ConclusionThe strategy of combination POCA and O-C2 angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.
ObjectiveTo explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes.MethodsOne hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared.ResultsThere were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups (P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups (P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA (P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation (P<0.05), and the scores were further improved at last follow-up (P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation (P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group (t=−2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group (P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group (P<0.05). No significant difference in the other radiographic parameters between the two groups were found (P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant (P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant (χ2=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant (χ2=1.190, P=0.276).ConclusionThe incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.