Zusammenfassung
Wir berichten über 146 Patienten, bei denen zwischen Juni 2002 und September 2010 insgesamt 246 Bryan-Endoprothesen implantiert wurden. Bei 74 Patienten (128 Prothesen), die länger als ein Jahr nachkontrolliert werden konnten, betrug der durchschnittliche Nachuntersuchungszeitraum 2,6 Jahre. Achtzehn Patienten bekamen nur in einem Segment eine Prothese (Gruppe 1), 77 Prothesen wurden multisegmental implantiert (Gruppe 2) und 33-mal wurden die Prothesen mit einer Fusion kombiniert (Hybridversorgung, Gruppe 3).
Die globale Lordose der HWS änderte sich nur geringfügig, eine Rekyphosierung trat v. a. bei den Hybridversorgungen auf. Die globale Beweglichkeit verbesserte sich in allen 3 Untersuchungsgruppen. Nur bei 2 Prothesen im Rahmen der Hybridversorgung war eine Einsteifung zu registrieren. Bei 5 Patienten musste im postoperativen Verlauf die Prothese ausgebaut und in eine Fusion umgewandelt werden.
Wesentliche Voraussetzungen für eine nachhaltige Funktionsfähigkeit der Bryan-Endoprothese sind die gradgenaue präoperative Planung und eine subtile Operationstechnik. Eine Hybridversorgung sollte nicht einzeitig durchgeführt werden.
Abstract
We report on the results of 246 Bryan cervical discs, which were implanted between June 2002 and September 2010 in 146 patients. Of the patients 74 (128 prostheses) could be followed up for more than 1 year and the average follow-up period was 2.6 years. Of the patients 18 were operated on at one level (group 1), 77 prostheses were multilevel surgery (group 2) and with 33 patients arthroplasty was combined with fusion (hybrid, group 3).
The global lordosis remained unchanged during follow-up and a recurrence of kyphosis was evident in group 3. The overall mobility improved in all 3 subgroups and 2 cases (group 3) fused. With 5 patients the prosthesis had to be removed and the segment had to be fused in the postoperative course.
As a conclusion a meticulous preoperative planning as well as a subtle surgical technique is the main prerequisite for long-lasting mobility of the Bryan prosthesis.
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Carstens, C., Carstens, M. & Copf, F. Die Bedeutung des sagittalen Profils bei der zervikalen Endoprothetik. Orthopäde 40, 719–725 (2011). https://doi.org/10.1007/s00132-011-1801-y
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DOI: https://doi.org/10.1007/s00132-011-1801-y