腰椎人工髓核假体置换后并发症及疗效评估  

Complications and clinical outcomes of prosthetic disc nucleus replacement

作　　者：唐恒涛[1] 赵亮[1] 蒋辉[1] 张忠民[1] 金大地[1] 

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

出　　处：《中国组织工程研究与临床康复》2008年第13期2437-2441,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的：总结分析腰椎人工髓核假体置换后并发症发生情况,在早期临床随访的基础上,比较人工髓核假体置换与传统开窗腰椎间盘髓核摘除治疗腰椎间盘突出症的中、远期疗效。方法：选择2002-02/2005-08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治疗单节段腰椎间盘突出症患者98例,获得24~60个月随访患者63例。另外随机选择同期同年龄段单节段腰椎间盘单纯开窗髓核摘除患者200例,获有效随访94例。采用Oswestry功能障碍指数和Stauffer-coventry疗效评定标准评价疗效,影像学分析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。腰椎活动度=后伸角度-前屈角度;椎间隙高度变化采用病变椎间隙前后缘高度均值与上位椎体中部矢状径的比值表示。结果：①单纯髓核摘除组8例患者术后复发,行二次椎间盘手术;人工髓核假体置换组3例假体脱出二次翻修将假体取出。其余患者治疗后临床症状均明显改善。②两组Oswestry功能障碍指数各随访时间点均较术前明显降低,差异有显著性意义（P〈0.05）。③两组Stauffer-coventry疗效评估各随访时间点差异无显著性意义（P〉0.05）。④随访中远期（3.0～5.0年）人工髓核假体置换组手术节段腰椎活动度均优于单纯椎间盘摘除组,差异有显著意义（P〈0.05）。⑤人工髓核假体置换组椎间隙高度比值各随访时间点与术前比较,差异具有显著性意义（P〈0.05）。⑥主要并发症：人工髓核假体置换组早期出现术后一过性腰痛24例,假体脱出3例。中、远期发现假体下沉32例,软骨终板损伤39例。单纯髓核摘除组8例术后复发。所有病例无术后感染发生。结论：人工髓核假体置换存在较严重并发症,人工髓核假体置换与传统腰椎间盘开窗髓核摘除中、远期疗效无明显差异。AIM： To summarize the complications following lumbar prosthetic disc nucleus （PDN） replacement to compare the mid- and long-term clinical outcomes of PDN replacement and classical lumbar disceetomy for lumbar disc protrusion （LDP） based on early clinical follow-up. METHODS： Ninety-eight patients with LDP in single segment were implanted PDN device in Department of Orthopeadics and Spinal Surgery, Nanfang Hospital, Southern Medical University from February 2002 to August 2005, and 63 of them were followed up for 24-60 months. In addition, 200 LDP patients who received open window lumbar discectomy in the same duration were randomly selected, and 94 of them were followed up. Oswestry questionnaire index and Stauffer-coventry score were investigated. Lumbar condition （range of motion, and intervertebral space height） of patients was appraised by their pre- and post-operative radiographic examination （X-ray or MRI） and prosthesis location was observed. Lumbar range of motion= Backward extension angle-forward flexion angle. Intervertebral height changes were represented by the ratio of anterior and posterior border mean height of affected intervertebral space and sagittal diameter of middle upper adjacent vertebral body. RESULTS： （1）Eight patients of lumbar discectomy group relapsed after surgery and underwent another discectomy. Prosthesis dislocation occurred in 3 cases of PDN replacement group and removed by revision. The clinical symptoms in the other patients were significantly improved postoperatively. （2）Oswestry disability indexes of PDN and discectomy group were significantly decreased after operation （P 〈 0.05）. （3）The Stauffer-coventry score results showed there were no significant differences between the two groups at each time point during follow-up （P 〉 0.05）. （4）During mid and long-term follow up （3.0-5.0 years）, the lumbar mobility of operated segment in the PDN groups was significantly better than the discectomy group （P 〈 0.05）. （5）There

关 键 词：人工髓核 腰椎 椎间盘移位 人工假体 

分 类 号：R318[医药卫生—生物医学工程]