腰椎人工椎间盘置换术不同适应证的临床疗效对比

doi:10.3969/j.issn.1006-7795.2013.02.019

摘要/Abstract

摘要：

目的比较腰椎人工椎间盘置换术的不同适应证的临床疗效。方法自1999年12月至2006年12月,首都医科大学附属北京朝阳医院骨科使用Charite SB Ⅲ假体进行人工腰椎间盘置换术治疗65例腰椎间盘退行性病变的患者。共有48个患者获得平均8.3年(5.2至11.1年)的随访,根据患者的术前诊断,把患者分为3组:1 椎间盘源性腰痛(discogenic low back pain)的患者9例;2 椎间盘退变(degenerative disc disease,DDD)合并腰椎间盘突出(nucleuse pulposus prolapse,NPP)的患者35例;3 髓核单纯摘除术后复发(post-disctomy)的患者4例。分别在术前、术后1个月、6个月、12个月、24个月及末次随访时对患者进行VAS疼痛评分(visual analogue score,0~100分)和Oswestry功能评分(oswestry disability index,%),并拍腰椎正侧位、动力位片,测量术前及随访期间手术节段的活动度(range of motion,ROM)。对上述数据进行统计学分析。结果组内比较结果:在随访期间,3组患者的VAS评分、ODI评分都有明显改善,与术前评分相比,差异均有统计学意义(P<0.05);随访期间,3组患者的手术节段活动度得到很好的保持,与术前相比,差异均无统计学意义(P>0.05)。组间比较:椎间盘退变合并腰椎间盘突出的患者术前评分较其他两组高,差异有统计学意义(P<0.05);末次随访时,各组之间评分无显著性差异(P>0.05),但椎间盘退变合并腰椎间盘突出的患者的评分缓解率好于其他两组(P<0.05);术前及各随访时间段,3组患者的手术节段活动度差异无统计学意义(P>0.05)。结论椎间盘源性腰痛、椎间盘退变性合并腰椎间盘突出、髓核单纯摘除术后复发都是腰椎人工椎间盘置换术较好的适应证,对于椎间盘变性合并腰椎间盘突出的患者,人工椎间盘置换术是一种较好的治疗方法。

关键词: 腰椎, 人工椎间盘置换, 临床疗效, 适应证

Abstract:

Objective To retrospectively compare the clinical effects of total disc replacement for different indications. Methods From December 1999 to December 2006, 65 patients suffered from degenerative disc diseases were treated with Charite SB Ⅲ disc replacement. The patients were subdivided into 3 groups according to their diagnosis: 1 nine patients with discogenic low back pain; 2 thirty-five patients with degenerative disc disease(DDD), accompanying soft disc herniation(nucleus pulposus prolapse, NPP); 3 four patients with recurrence of NPP after disctomy. All patients were evaluated by VAS Score(0-100 pts) and ODI Score(%) pre-operatively and 1, 3, 6, 12, 24 months after surgery and at the final follow-up. Radiographic parameters as range of motion(ROM) of the index level were evaluated by A-P and dynamic X-Ray. Statistical calculations were conducted with the above data. Results Comparing results in each group: during the follow-ups, in the three groups significant differences were found in VAS Score and ODI Score compared with those before surgery; during the follow-ups, the ROM in three groups were well maintained and showed no significant difference with that before surgery. Compared results among groups: pre-operative VAS Score and ODI Score of patients with DDD accompanying NPP were higher than those of other two groups. At the final follow-up, there was no significant difference of VAS Score and ODI Score among three groups, but patients with DDD accompanying NPP had a better remission rate. During the follow-ups, the ROM in three groups were well maintained and showed no significant difference with that before surgery. At the final follow-up, there are no significant differences among the different groups. But patients with DDD accompanying NPP achieved better remission rate than the other two groups(P<0.05). There was no significant difference among the three groups pre-operatively and during the follow-ups. Conclusion Discogenic low back pain, DDD accompanying NPP and recurrence of NPP after disctomy are good indications for TDR. For patients with DDD accompanying NPP, TDR is an excellent choice.

Key words: lumbar spine, total disc replacement, clinical effects, indication

中图分类号:

R681.5⁺3

王宇, 孔超, 鲁世保, 海涌, 王庆一, 藏磊, 孟祥龙. 腰椎人工椎间盘置换术不同适应证的临床疗效对比[J]. 首都医科大学学报, 2013, 34(2): 264-269.

WANG Yu, KONG Chao, LU Shibao, HAI Yong, WANG Qingyi, ZANG Lei, MENG Xianglong. Comparison of clinical effects of total lumbar disc replacement for different indications[J]. Journal of Capital Medical University, 2013, 34(2): 264-269.

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