人工髓核置换治疗腰椎间盘突出症后近期效果:与传统腰椎间盘切除加脊柱融合术比较  

Short-term effect of prosthetic disc nucleus replacement for lumbar disc herniation:A comparison with traditional lumbar spinal fusion

作　　者：庄超[1] 王黎明[1] 王刚锐[1] 徐燕[1] 

机构地区：[1]南京医科大学附属南京第一医院骨科,江苏省南京市210006

出　　处：《中国组织工程研究与临床康复》2008年第4期606-610,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:为进一步验证人工髓核置换是一种治疗腰椎间盘突出症的安全有效的治疗方法,比较人工髓核置换和传统腰椎间盘切除加脊柱融合在治疗单节段腰椎间盘突出症的近期疗效。方法:2005-08/2007-08南京医科大学附属南京第一医院骨科共收治腰椎间盘突出症患者38例,所有患者对实验及治疗方案均知情同意。分为人工髓核置换组14例,常规手术组24例。所有患者均为单节段病变。人工髓核置换组采用后侧入路,行单枚人工髓核植入,人工髓核为欧洲Raymedica公司生产的假体,其外衣为聚乙烯纤维,核心为能吸水膨胀的半流动性水凝胶(聚丙稀-聚丙烯酰胺);常规手术组经后侧入路,行腰椎间盘切除加脊柱融合术,采用山东威高骨科材料有限公司脊柱内固定系统13例,中华长城脊柱内固定系统11例;采用Wright Medical Technology,Inc.人工骨17例,上海贝奥路生物材料有限公司磷酸钙生物陶瓷7例。比较两组手术切口长度,术中出血量,手术时间,术后住院时间,术后椎间隙增加高度,术前及术后6周,3,6个月Oswestry疼痛功能指数评分和视觉模拟疼痛评分,并根据JOA标准进行临床疗效评价。结果:患者38例全部进入结果分析,全部病例随访6～18个月,平均13.4个月。①人工髓核置换组切口长度、术中出血少于常规手术组,两组相比差异有显著性意义(P<0.05)。②人工髓核置换组手术时间、术后住院时间短于常规手术组,两组相比差异有显著性意义(P<0.05)。③人工髓核置换组术后椎间隙增加高度与常规手术组比较差异无显著性意义(P>0.05)。④人工髓核置换组Oswestry疼痛功能指数评分在第3个月较常规手术组有显著下降(P<0.05);视觉模拟疼痛评分两组差异无显著性意义(P>0.05)。⑤两组临床疗效优良率比较差异无显著性意义(P>0.05)。⑥人工髓核置换组并发症:术后1年发生假体移位1例,但无症状,无需再次手术;AIM： The purpose of this study was to compare the short-term effect of prosthetic disc nucleus replacement with traditional lumbar spinal fusion for the treatment of single-level lumbar disc hemiation and prove prosthetic disc nucleus replacement is a safe and effective surgery. METHODS： From August 2005 to August 2007, 38 cases of lumbar disc hemiation from Department of Orthopedics, Nanjing First Hospital Affiliated to Nanjing Medical University were enrolled. All patients signed the informed consent. They were divided into a prosthetic disc nucleus replacement group （n =14） and a fusion group （n =24）. All the patients only had single disc protrusion. Patients in the prosthetic disc nucleus replacement group received signal prosthetic disc nucleus replacement replacement through posterior approach. Prosthetic disc nucleus was the prosthesis produced by Europe Raymedica Company. Its cover was polyethylene fiber and core was semifluid hydrogel that could suck water （polyacrylonitrile-polyacrylamide）. The patients in the fusion group received lumbar spinal fusion through posterior approach. There were 13 cases of spine intemal fixation system of Shandong Weigao Orthopedics Material, Inc; 11 cases of spine intemal fixation system of China Great Wall; 17 cases of substitute bone of Wright Medical Technology, Inc; 7 cases of calcium phosphate bioceramics of Shanghai Beiaolu Biomaterial, Inc. Length of incisions, the intro-operative blood loss, time of surgery, postoperative hospital stays, postoperative increase of disc height, Oswestry Disability Index and Visual Analogue Pain Scale before and at weeks 6, months 3 and 6 after the surgery were compared between the two groups. The clinical outcomes were evaluated with JOA Index. RESULTS： Thirty-eight patients were involved in the result analysis. The patients were followed up from 6 to 18 months with an average of 13.4 months. ①The length of incisions was shorter and intro-operative blood loss was less in the prosthetic disc nucleus replacement

关 键 词：腰椎间盘突出症 人工髓核 置换 生物植入体 组织工程 

分 类 号：R318[医药卫生—生物医学工程]