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Bryan人工间盘置换术对颈椎退行性疾病患者颈椎运动功能及邻近节段退变的影响陈晓磊【期刊名称】《《颈腰痛杂志》》【年(卷),期】2019(040)006【总页数】2页(P850-851)【关键词】Bryan人工间盘置换术; 颈椎退行性疾病; 颈椎运动功能; 邻近节段退变【作者】陈晓磊【作者单位】河南医学高等专科学校附属医院外一科河南郑州451191【正文语种】中文【中图分类】R681.55表1 两组患者术前、末次随访时JOA、VAS、NDI评分比较分)组别例数JOA评分术前末次随访VAS评分术前末次随访NDI评分术前末次随访融合组559.64±1.1615.36±1.05∗6.83±2.471.87±1.02∗31.26±10.9714.18±3.76∗置换组4310.00±1.2315.01±1.54∗7.02±2.261.72±1.13∗31.75±11.2413.53±3.05∗P0. 1410.1850.6960.4920.8290.359注：与同组术前比较，*P<0.05表2 两组患者术前、末次随访颈椎整体活动度、邻近节段活动度比较组别例数颈椎整体活动度术前末次随访上邻近节段活动度术前末次随访下邻近节段活动度术前末次随访融合组5546.19±13.6435.07±9.41∗10.73±4.359.53±5.129.89±5.1310.18±4.48置换组4344.16±14.6745.38±10.699.86±3.679.00±3.799.36±3.648.57±3.49P0.481< 0.0010.2960.5710.5670.055注：与同组术前比较，*P<0.05表3 两组患者末次随访邻近节段退变比较[n(%)]组别例数上邻近节段退变X线MRI下邻近节段退变X线MRI融合组5511(20.00)16(29.09)13(23.64)15(27.27)置换组434(9.30)5(11.63)3(6.98)4(9.30)P0.1440.0360.0270.025临床上颈椎退行性疾病治疗多以手术为主，其中颈前路减压融合术为颈椎病治疗金标准，能有效解除脊髓神经压迫，重建脊柱稳定，但长时间随访发现该术式会引发邻近节段退变、生理活动减弱或丧失等并发症[1]。
英汉对照骨科患者指南032：颈痛（下）Neck Pain颈痛A Patient’s Guide to Neck Pain颈痛患者指南Symptoms症状What are some of the symptoms of neck problems?颈椎疾病可引起什么症状？Symptoms from neck problems vary. They depend on your condition and which neck structures are affected. Some of the more common symptoms of neck problems are颈椎疾病的症状因人而异。
取决于你的病情和哪部分颈椎结构受累。
颈椎疾病最见的症状有：· neck pain· headaches· pain spreading into the upper back or down the arm· neck stiffness and reduced range of motion· muscle weakness in the shoulder, arm, or hand· sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers•颈痛•头痛•疼痛放射至后背或胳膊•颈部僵硬，活动范围减少•肩膀、胳膊或手部肌肉无力•前臂、手或手指的感觉改变（麻木、针刺感、刺痛）Diagnosis诊断How will my doctor find out what is causing my problem?我的医生该如何找到我的病因？The diagnosis of neck problems begins with a thorough history of your condition. You might be asked to fill out a questionnaire describing your neck problems. Then your doctor will ask you questions to find out when you first started having problems, what makes your symptoms worse or better, and how the symptoms affect your daily activity. Your answers will help guide the physical examination.颈椎疾病的诊断始于详细的病史。
第20卷第2期中国现代医学杂志Vol.20No.2 2010年1月China Journal of Modern Medicine Jan.2010颈椎前路减压植骨融合术是治疗颈椎病的经典标准术式，因其手术创伤小，减压直接彻底和有效恢复颈椎生理曲度等优点而获得广泛应用[1]。
但是，随着ACDF治疗随访时间的延长，术后融合椎体相邻节段退行性改变的现象已经引起越来越多脊柱外科医生的重视[2]，认为颈椎融合相邻节段加速退变是自然退变和融合后颈椎生物力学改变共同作用的结果[3]。
颈人工椎间盘置换是近年来新兴的治疗颈椎疾患的术式，它在有效减压的同时，能够通过植入人工椎间盘保留减压节段的活动度，从而较好地解决了减压与保留颈椎运动节段的矛盾，避免了临近节段的退变加速[4]。
我院自2006年5月～2009年3月采用Bryan人工颈椎间盘（Bryan disc）置换治疗脊髓型颈椎病患者8例，经24～42个月的随访，中期效果满意。
1资料与方法1.1资料本组资料8例，均为脊髓型颈椎病患者，男性2例，女性6例；年龄36～58岁，平均41.8岁；病程8～24个月，平均13.9个月。
病变节段：均为单节段，C4～5有5例，C5～6有3例。
X射线平片未发现颈椎不稳，M RI示患者均存在颈椎间盘突出或脱出。
置换前病变节段前屈后伸活动范围平均7.1°（5.4°～8.7°）；左右侧屈活动范围分别为平均5.7°（5.3°～6.0°）和5.6°（5.3°～5.8°）；日本骨科学会颈椎病评分（Japanese Orthopedics Academy，JOA）为6～12分，平均8.7分。
1.2治疗方法术前准备：置换前常规行颈椎正、侧、前屈、后伸位X射线平片和M RI检查，常规进行气管推移训练。
手术方法：患者全麻后仰卧于手术台上，颈部垫软枕，保持颈部稍后伸，用宽胶布固定患者头和躯干于手术台上，在整个手术过程中体位保持不变。
英汉对照骨科患者指南015：颈椎解剖Cervical Spine Anatomy颈椎解剖A Patient’s Guide to Cervical Spine Anatomy颈椎解剖患者指南Introduction简介Knowing the main parts of your neck and how these partswork is important as you learn to care for your neck problem.了解颈部的主要构成以及这些结构如何运作对于你学习应对颈部疾病非常重要。
Two common anatomic terms are useful as they relate to the neck. The term anterior refers to the front of the neck. The term posterior refers to the back of the neck. The part of the spine that moves through the neck is called the cervical spine. The front of the neck is therefore called the anterior cervical area. The back of the neck is called the posterior cervical area.谈到颈椎有两个常用的解剖术语很有用。
“前”这个术语指颈椎的前面，“后”这个术语指颈椎的背面。
颈部的这段脊柱称为颈椎。
颈椎的前面称为颈前区，颈椎的背面称为颈后区。
This guide gives a general overview of the anatomy of the neck. It should help you understand本指南对颈椎解剖作了简要介绍，有助于你理解：· what parts make up the neck· how these parts work•颈椎的构成•这些结构如何运作Important Structures重要结构The important parts of the cervical spine include颈椎的重要结构包括：· bones and joints· nerves· connective tissues· muscles· spinal segments•骨与关节•神经•结缔组织•肌肉•脊髓节段This section highlights important structures in each category. 这一节着重讲述每一类重要的结构。
Discover人工颈椎间盘置换治疗颈椎病的早期临床疗效观察（全文）【摘要】目的探讨Discover 人工颈椎间盘置换术治疗颈椎病的早期临床疗效。
方法选择2009.7-2012.07 在我院脊柱外科接受Discover 人工颈椎间盘置换的颈椎病患者30 例，单节段置换23 例, 双节段5 例，双节段加颈前路钢板固定2例。
于置换前、置换后7d，3，6，12，24，36 个月行JOA 评分、NDI 评分、Odom’s 评分；以颈椎正侧位及动力位X 线片测量手术节段、邻近节段及C2-7 屈伸活动度的变化情况。
结果患者术后随访时临床症状均明显缓解，疗效满意。
患者JOA 评分改善率随时间延长逐渐提高，各个随访点均较术前明显提高，差异有统计学意义（P ＜0.05）；NDI 评分由术前的（53.3±10.1）％降低到末次随访时的（22.2±9.8）％，差异有统计学意义（P＜0.05）。
按照Odom’s 评定标准，末次随访时：优23 例，良6 例，可1 例，优良率96.5％。
置换3 个月之后各随访点的手术节段、邻近节段及C2-7 屈伸活动度与置换前相近，差异无统计学意义(P＞0.05)。
结论 Discover 人工颈椎间盘置换的早期临床疗效优良，能够较好的保留了颈椎的手术节段、邻近节段及整体的活动度。
【关键词】Discover；颈椎病；人工颈椎间盘置换活动度颈椎病系指因颈椎间盘退变及其继发性该变，刺激或压迫相邻脊髓、神经、血管和食管等组织，并引起症状和体征者。
它是脊柱外科的常见病、多发病，严重影响患者的身心健康和生活质量。
长期以来，颈椎病的经典手术术式为颈前路椎管减压椎间植骨融合内固定术，然而因融合导致邻近节段退变加速、假关节形成、颈椎的整体活动范围降低等并发症日趋引起学者们的关注。
人工颈椎间盘置换术正是在既要达到颈前路椎管减压椎间植骨融合内固定术的临床疗效，又要保持颈椎稳定和节段活动的临床需求中应运而生。
英汉对照骨科患者指南005：颈椎椎体次全切除植骨术患者指南（下）Cervical Corpectomy and Strut Graft颈椎椎体次全切除术和支撑植骨术A Patient’s Guide to Cervical Corpectomy and Strut Graft颈椎椎体次全切除术和支撑植骨术患者指南Complications并发症What might go wrong?会有什么并发症？As with all major surgical procedures, complications can occur. Some of the most common complications following corpectomy surgery include所有主要的外科手术，都可能出现并发症。
椎体次全切除术的并发症主要包括以下几个方面：· problems with anesthesia· thrombophlebitis· infection· nerve damage· problems with the graft or hardware· nonunion· ongoing pain•麻醉风险•血栓性静脉炎•感染•神经损伤•移植骨和内固定的问题•骨不连•持续的疼痛This is not intended to be a complete list of the possible complications, but these are the most common.这里没有列出所有可能发生的并发症，但这些是最常见的。
Problems with Anesthesia麻醉风险Problems can arise when the anesthesia given during surgery causes a reaction with other drugs the patient is taking. In rare cases, a patient may have problems with the anesthesia itself. In addition, anesthesia can affect lung function because the lungs don’t expand as well while a person is under anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.手术过程中麻醉药品与病人服用的其他药物产生反应时，可能会出现问题。
英汉对照骨科患者指南002：人工颈椎间盘置换术（上）Cervical Artificial Disc Replacement人工颈椎间盘置换术A Patient’s Guide to Cervical Artificial Disc Replacement人工颈椎间盘置换术指南Introduction简介Artificial disc replacement(ADR) is relatively new. In June 2004, the first ADR for the lumbar spine (low back) was approvedby the FDA for use in the US. Replacing a damaged disc in the cervical spine (neck) is a bit trickier. The disc is part of a complex joint in the spine. Making a replacement disc that works and that will last is not an easy task. There are now several Cervical artificial disc replacement devices that have been approved by the FDA for use in the United States.相比较而言，人工颈椎间盘置换术是一项新技术。
在2004年6月，美国FDA批准开展了第一例人工腰椎间盘置换术。
而置换受损的颈椎间盘有点棘手。
椎间盘是脊柱中复杂关节的一部分。
想要让置换的椎间盘能运作并能持久发挥作用，这并非易事。
现如今有几种人工颈椎间盘置换装置已经在美国获得FDA的批准。
动画：人工腰椎间盘置换术精美动画：人工颈椎间盘置换术（附中英文解说）The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion. The hope is that your spine will be protected from similar problems above and below the affected spinal level.人工间盘植入于两椎体间。
其目的是置换病变或损伤的椎间盘并保持颈部正常的运动。
希望保护你的脊柱免受相邻病变椎节的影响而产生类似问题。
This guide will help you understand:本指南将帮助您了解以下内容：· what parts of the spine are involved病变脊柱部位· what your surgeon hopes to achieve外科医生预期疗效· who can benefit from this procedure手术适用人群· how do I prepare for surgery手术准备· what happens during the procedure手术步骤· what to expect as you recover术后康复Anatomy解剖What parts of the spine are involved?涉及到哪个部位的脊柱？Disc replacement typically occurs at cervical spine levels C4-5, C5-6, or C6-7. The first seven vertebrae make up the cervical spine. Doctors often refer to the cervical vertebrae as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom of the skull. The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine (the chest area) at the first thoracic vertebra, T1.通常椎间盘置换在颈4-5、5-6或6-7颈椎水平进行。
头端七个椎体构成了颈椎。
医生们经常所指的颈椎是指颈1到颈7。
颈椎起始于颈1与颅底的连接处。
颈椎曲度轻度前凸，终止于颈7在胸1连接胸椎处。
Each vertebra is made of the same parts. The main section of each cervical vertebrae, from C2 to C7,is formed by a round block of bone, called the vertebral body. A bony ring attaches to the back of the vertebral body. This ring has two parts. Two pedicles connect directly to the back of the vertebral body. Two lamina bones join the pedicles to complete the ring. The lamina bones form the outer rim of the bony ring. When the vertebrae are stacked on top of each other, the bony rings form a hollow tube that surrounds the spinal cord. The laminae provide a protective wall around the spinal cord.每个椎体由类似的部分构成。
从颈2到颈7，每个颈椎的主要部分是由被称之为椎体的圆形骨块构成。
一个骨性环连接椎体背侧。
骨环有两部分构成。
两个横突直接连接椎体背侧。
两侧椎板连接横突封闭骨环。
椎板构成了骨环的外侧边缘。
当脊椎相互堆叠，骨环则组成了一个围绕脊髓的中空管道。
横突提供了围绕脊髓的保护结构。
On the left and right side of each vertebra is a small tunnel called a neural foramen. (Foramina is the plural term.) The two nerves that leave the spine at each vertebra go through the foramina, one on the left and one on the right. The intervertebral disc sits directly in front of the opening. A bulged or herniated disc can narrow the opening and put pressure on the nerve.A facet joint sits behind the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve.一个称之为神经孔的小孔道位于每个脊椎的左右两侧。
每个脊椎中分出两条神经通过神经孔一左一右离开脊柱。
椎间盘直接位于神经孔开口前方。
膨出或者突出的椎间盘能使开口变得狭窄继而使神经受压。
关节突关节位于神经孔后方。
形成于关节突关节的骨刺能突入孔道，狭窄孔道挤压神经。
A special type of structure in the spine called an intervertebral disc has two parts. The center, called the nucleus, is spongy. It provides most of the shock absorption in the spine. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it.脊柱中一个特殊结构称为椎间盘，它有两部分。
中心富有弹性的称为髓核。
它提供大部分的缓冲。
髓核受纤维环局限，纤维环是围绕髓核的坚韧的韧带组织。
Related Document: A Patient’s Guide to Cervical Spine Anatomy相关文献：颈椎解剖指南英汉对照：有关颈椎解剖的病人指南精美动画：颈椎解剖动画演示Rationale理论基础What does the surgeon hope to achieve?外科医生希望达到什么？精美动画：颈椎间盘退变性疾病Disc replacement surgery is done to stop the symptoms of degenerative disc disease. Discs wear out or degenerate as a natural part of aging and from stress and strain on the neck. Eventually, the problem disc collapses. This causes the vertebra above to sink toward the one below. This loss of disc height affects the nearby structures – especially the facet joints.椎间盘置换手术目的在于阻断退变性椎间盘疾病的症状。
由于自然老化或者颈部压力以及应力，椎间盘出现损伤或者退变。
最终，病变椎间盘严重损坏。
