人工髓核假体置入治疗腰椎间盘突出症的疗效分析  

Prosthetic disc nucleus replacement for lumbar intervertebral disc herniation

作　　者：赵亮[1] 瞿东滨[1] 陈建庭[1] 江建明[1] 蒋晖[1] 金大地[1] 

机构地区：[1]南方医科大学附属南方医院脊柱骨病外科,广东省广州市510515

出　　处：《中国组织工程研究与临床康复》2007年第16期3127-3130,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:观察已在临床初步开展起来的人工髓核置换术治疗腰椎间盘突出症的中、远期临床疗效及并发症,分析其对策。方法:纳入2002-02/2004-08南方医科大学附属南方医院脊柱骨病外科采用单枚人工髓核假体置换术治疗单节段腰椎间盘突出症患者98例,获得24～48个月随访患者75例,按平均随访时间达24,36,48个月,分为24个月组(n=30),36个月组(n=23),48个月组(n=22)。选同期采用单纯椎间盘髓核摘除术患者30例作为对照组,评估各组术后临床疗效,主观症状采用Oswestry功能障碍指数问卷表(0%表示正常,越接近100%则功能障碍越严重)和Prolo功能评分表(小于或等于5分为差,6～7分为中等,8～10为优)评价,分析术后影像学检查并测量手术节段活动度和椎间隙高度变化情况,同时观察假体位置情况,腰椎MRI观察假体位置和软骨终板的信号变化情况。腰椎活动度=(腰椎中立角度-前屈角度)+(后伸角度-腰椎中立角度)=后伸角度-前屈角度;为消除X射线放大率的影响,椎间隙高度变化情况采用病变椎间隙后缘高度与上位椎体中部矢状径的比值表示。结果:75例获得24～48个月随访者,全部进入结果分析。①48个月组2例、36个月组1例发生假体脱出,二次手术取出。其余患者术后临床症状均明显缓解,疼痛消失。②24,36,48个月组及对照组术后末次Oswestry功能障碍指数均较术前降低,差异有显著性意义(14.2%,52.1%;15.5%,55.2%;15.1%,53.6%;15.5%,51.5%;P<0.05)。③24,36,48个月组及对照组术后末次Prolo能评分均较术前升高,差异有显著性意义(8.5,4.6分;8.6,4.5分;8.7,4.3分;8.4,4.2分;P<0.05)。④24,36,48个月组同期手术节段腰椎活动度均高于对照组,差异有显著意义(P<0.05)。⑤24个月组手术节段椎间高度较术前降低约4%、36个月组降低约12%、48个月组降低约18%、对照组较术前降低约25%,各组术前和术后椎间隙高度比值比较,差异具有显著性�AIM： To evaluate the medium and long-term clinical effect and the complication of prosthetic disc nucleus （PDN） replacement for the treatment lumbar intervertebral disc herniation, so as to explore the reasons and proper treatment. METHODS： Totally 98 patients with lumbar intervertebral disc herniation of single segment and underwent the implantation of PDN device were selected from the Department of Orthopeadics and Spinal Surgery, Nanfang Hospital, Southern Medical University between February 2002 and August 2004. Seventy-five patients were followed up for 24- 48 months, and divided into 24 months follow-up group （group A, n =30）, 36 months group （group B, n =23） and 48 months group （group C, n =22） according to the time. Thirty cases of nucleus gelatinosus removal were selected as the control group. The Oswestry questionnaire index （0% as normal, near 100% as severe） and Prolo Functional Economic Rating Scale, in,which ≤ 5 points as bad, 6-7 as medium and 8-10 as excellent, were used to determine the clinical outcome after operation. Then, they were given radiographic examination. The operation segment activity, intervertebral height changes, and prosthetic location were detected, the signal changes in cartilage end plate were observed by MRI. Spinal mobility=（lumbar neutral angle-forward flexion angle） ＋ （backward flexion angle-lumbar neutral angle）=backward flexion angle-forward flexion angle; the intervertebral height changes were represented by the ratio of the posterior border height of diseased intervertebral space and sagittal diameter of middle upper centrum to eliminate the influence of X-ray magnification. RESULTS： The 75 cases with 24-48 month follow-up were all involved in the result analysis. （1）After implantation, most patients experienced pain relief, except for 2 in the group C and 1 in the group B with prosthesis dislocation and reversion. （2）The final Oswestry.disability indexes of groups A, B and C and control group were decreased compared wi

关 键 词：假体植入 腰椎/外科学 椎间盘/外科学 椎间盘移位/外科学 

分 类 号：R318.1[医药卫生—生物医学工程]