| Background:With the increasing pressure of daily life and the quickening pace of life,working hours and learning hours such as teachers are increasing.At the same time,with the emergence of new things such as smart phones,more and more people have become "lowers".In recent years,the prevalence of cervical spondylosis(cervical spondylosis)is increasing and showing a younger development.Cervical disc herniation and cervical spinal canal stenosis are common forms of cervical spondylosis.The former is the nucleus pulposus that breaks through the fibrous ring or even the posterior longitudinal ligament,the posterior compression of the spinal cord or the backward oppression of the nerve roots,resulting in the corresponding local symptoms and neurological symptoms;the latter refers to the degeneration of the cervical intervertebral disc and the degeneration of the secondary intervertebral joint.The corresponding symptoms and signs of spinal cord,nerve and blood vessels.Common in middle-aged people,the main clinical symptoms depend on the oppressed tissue and degree of oppression.The classic types of cervical spondylosis include four types:cervical spondylotic radiculopathy,spinal type(cervical spondylotic myelopathy),vertebral artery type(arteria vertebralis type),and sympathetic cervical spondylosis(sympathetic cervical spondylosis).The pain in the back and shoulder of the neck can be accompanied by radiation pain of the upper limb.The serious movements of the hands are not flexible and unstable.These symptoms can affect the normal quality of life of the patients.Conservative treatment of cervical spondylosis is suitable for patients with no obvious neurological dysfunction,including rest,immobilization,traction,medication and functional exercise.For the patients with spasmodic gait,fine movement of the hand,dysuria and the symptoms of nerve root,the patients who have no systematic conservative treatment should be treated with surgical treatment.At present,surgical approaches can be divided into anterior and posterior approaches according to different approaches.Among them,the classic operation of the anterior approach is without doubt for the anterior cervical decompression and fusion internal fixation(Anterior cervical corpectomy decompression and fusion ACDF).Since the middle of the twentieth Century,anterior cervical discectomy and interbody fusion have been reported for the first time,and it has developed rapidly.Its curative effect has been widely recognized and has become the most widely used mode of operation.The operation achieved complete decompression of the intervertebral discs and intervertebral bone graft fusion to achieve decompression and vertebral fusion.It is the most important step to remove the spinal cord and nerve root compression thoroughly and safely.The interbody fusion can promote the fusion of the surgical segment,maintain the stability of the cervical vertebra,but reduce the movement segment of the cervical spine.Therefore,cervical intervertebral discectomy(ACDF)is a "gold standard" for the treatment of cervical spondylosis,but there are many complications in the vertebral fusion,such as the degeneration of the adjacent segments of the upper and lower segments of the surgical segment.In the early twenty-first Century,cervical disc replacement was gradually recognized and became a new cervical spine operation.The first application of Bryan artificial cervical disc replacement for cervical spondylosis in the treatment of cervical spondylosis was first applied and reported in 1950 by Goffin.The greatest advantage is that the operation can preserve the activity of the cervical vertebra to the maximum degree while completing the complete decompression,in addition to reducing the degeneration of the adjacent segments.Bryan artificial cervical disc replacement,while completing the complete decompression,also preserves the height and activity of the segment and adjacent segments of the cervical vertebra replacement,reducing the degeneration of adjacent segments and the occurrence of the corresponding diseases.However,with the increasing application of the population and the improvement of its own technology,a series of early and late complications,such as artificial cervical disc prosthesis sinking,loosening and removal,ectopic ossification has also aroused widespread attention.Heterotopic ossification has become the focus of attention.After cervical intervertebral disc replacement,if the segmental or adjacent segments of the cervical vertebra form ectopic ossification,the ossification can even lead to interbody fusion,which leads to the weakening or even loss of the activity of the cervical vertebra,and the adjacent segment degeneration is still unavoidable.Objectives:To study the formation of heterotopic ossification in patients with cervical total disc replacement(Bryan disc replacement)after a certain follow-up period,and to analyze and discuss the possible factors leading to the formation of ectopic ossification.Methods:From July 2013 to July 2015,70 cases of cervical disc replacement surgery in our hospital were analyzed.The patients were followed up for 3 months-2 years,with an average follow-up time of 11 months.There were 47 male patients and 23 female patients,aged 35-68 years,with an average age of 47.38 years.Of the 70 patients,17 were cervical spondylotic radicular spondylotic myelopathy,37 were cervical spondylotic myelopathy,and 16 were mixed cervical spondylosis.There were 44 cases of single segmental cervical disc replacement and 26 cases of two-level cervical disc replacement.3 months,six months and 1 years after the operation,the X-ray films of the cervical spine and the hyperextension and flexion of the cervical spine were reviewed in 2 years.The development degree of heterotopic ossification was measured and evaluated by the international general Me Afee classification method(grade 0-? grade),and related factors such as different age and sex may lead to heterotopic ossification.The analysis of the operation time and so on.Results:All patients were followed up for an average of 11 months in March,11 months after operation,and 70 patients were followed up for more than 3 months,of which the longest 21 months were 21 months,of which 16 patients had ectopic ossification,with a rate of 22.86%.Heterotopic ossification after a single segment and a double segmental prosthesis of cervical disc replacement.Of the 8 patients,there was a high incidence of heterotopic ossification in patients with double segmental cervical disc replacement.In addition,10 cases and 6 cases of heterotopic ossification were found in male and female patients,and there was no obvious influence on the formation and formation of heterotopic ossification after operation.The older patients were more likely to have ectopic ossification after operation,and 96 adjacent segments were analyzed by McAfee classification,and 50 adjacent segments were found to be heterotopic ossification,about 52.08%adjacent segment degeneration occurred,with the highest probability of occurrence of C5/6.Conclusion:The results showed that the incidence of heterotopic ossification in this follow-up period was still low after Bryan artificial cervical disc replacement.The analysis was related to the number of surgical segments and the age of the patients.The probability of ectopic ossification was not related to the sex of the patients.In addition,we also concluded that degeneration and heterotopic ossification can occur in adjacent segments after artificial cervical disc replacement,of which C5/6 segment is the most common.Compared with other cervical surgery,artificial cervical disc replacement is a new technique.After decades of rapid development,it has become a common method for treating degenerative cervical spondylosis,and the postoperative curative effect is significant.However,further follow-up and study are still needed to clarify the long-term clinical effect of the operation. |
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