山东医药2017，Vol.57Issue(4)：13-16,4.DOI:10.3969/j.issn.1002-266X.2017.04.002
颈椎退行性疾病 Bryan 间盘置换术后椎旁骨化影响因素分析
Influencing factors for paravertebral ossification in patients with cervical degenerative disease after Bryan artificial disc replacement
摘要
Abstract
Objective To discuss the relationship of segmental range of motion ( ROM) , implant deviation and im-plant tilt with the paravertebral ossification ( PO) in patients with cervical degenerative disease after Bryan cervical artificial disc replacement ( CADR) .Methods A total of 90 Bryan discs which were implanted into 76 patients with cervical de-generative disease were retrospectively analyzed .The average follow-up time was more than 10 years.The segmental ROM was measured by X-ray at the preoperation , 3 months′follow-up and the last follow-up.We used the coronal reconstruction CT to evaluate the implant deviation and implant tilt at the last follow-up, and determined the grades of PO by McAfee at the last follow-up.We retrospectively analyzed the influence factors of grade 4 PO as well as the relationship of segmental ROM, implant deviation and implant tilt with the grade of PO .Results The segmental ROM at preoperation , 3 months′follow-up and the last follow-up was 9.2°±4.7°, 8.2°±4.8°and 8.7 ±5.1°(all P>0.05).The segmental ROM at 3 months′follow-up and the last follow-up was positively correlated (r=0.572, P<0.01).The median and interquartile range of implant deviation was 0.61 (0-7.08) mm and 0.84 (0.01-9.79)°.The implant tilt was negatively correlated with segmental ROM at the last follow-up (r=-0.379, P=0.001).At the last follow-up there were 17 segments (15 pa-tients) with grade 4 PO and 73 segments (63 patients) with grade 0-3 PO.Patients who had grade 4 PO were older than the patients with the grade 0-3 PO (P<0.05).Patients with the grade 4 PO had less segmental ROM than that of patients with the grade 0-3 PO at the 3 months′and last follow-up (all P<0.01).The segment whose implant deviation was greater than 3 mm would have a higher PO grade (P<0.01), and less ROM at the last follow-up (all P<0.01).The segment whose implant tilt was greater than 5°would have a higher PO grade (P<0.01), and less ROM at the last follow-up (P<0.05).Conclusions Maintaining the segmental ROM after the early stage of CADR can avoid the grade 4 PO.The im-plant deviation or implant tilt will cause the higher grade of PO in the long-term follow-up and will influence the long term ROM, and especially we should avoid the implant deviation more than 3 mm or implant tilt more than 5°.关键词
颈椎退行性疾病/颈椎人工间盘置换术/节段活动度/假体位置/异位骨化/椎旁骨化Key words
cervical degenerative disease/cervical artificial disc replacement/segmental range of motion/prosthesis positioning/heterotopic ossification/paravertebral ossification分类
医药卫生引用本文复制引用
韩骁,田伟,刘波,何达,吕艳伟,马驰,王晋超..颈椎退行性疾病 Bryan 间盘置换术后椎旁骨化影响因素分析[J].山东医药,2017,57(4):13-16,4.基金项目
北京市科学技术委员会资助项目（Z161100000516134）；北京市医院管理局“青苗”计划专项经费资助（QML20160402）。 （）
