中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
8期
726-731
,共6页
夏群%徐宝山%张继东%苗军%白剑强%韩岳%刘艳成%宁尚龙%黄洪超%杨强%李建光%吉宁%胡永成
夏群%徐寶山%張繼東%苗軍%白劍彊%韓嶽%劉豔成%寧尚龍%黃洪超%楊彊%李建光%吉寧%鬍永成
하군%서보산%장계동%묘군%백검강%한악%류염성%저상룡%황홍초%양강%리건광%길저%호영성
椎间盘%腰痛%假体和植入物%治疗结果
椎間盤%腰痛%假體和植入物%治療結果
추간반%요통%가체화식입물%치료결과
Intervertebral disk%Low back pain%Prostheses and implants%Treatment outcome
目的 探讨椎间盘源性腰痛人工椎间盘置换术(artificial disc replacement,ADR)的中期疗效.方法 2004年7月至2007年7月采用ADR治疗椎间盘源性腰痛21例(24个椎间盘),男9例,女12例;年龄26～67岁,平均46岁.均经椎间盘造影明确诊断.手术节段:L4-5例,L5S113例,L4-5+L5S13例.SB CharitéⅢ型椎间盘假体22个,Activ L型椎间盘假体2个.集中随访时行X线、CT和MR检查,评估疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI).结果 随访时间4～7年,平均5.1年.(1)腰腿痛较术前明显缓解,腰痛、腿痛VAS及ODI与术前比较差异均有统计学意义.(2)未出现椎间盘假体脱出、断裂、塌陷及手术节段自发性融合.1例双间隙手术者术后出现腰椎轻度侧凸,1例单间隙手术者出现相邻节段骨质增生加重.(3)手术节段椎间隙前缘高度较术前平均增加6.3 mm,后缘高度平均增加1.9 mm,节段性前凸角平均增加2.9°,椎间活动度平均为4.6°.近侧相邻节段椎间活动度平均减少2.5°.腰椎前凸角平均增加7.8°,腰椎屈伸活动范围平均增加2.4°.(4)近侧相邻节段椎间盘退变MR分级及关节突关节退变CT分级无明显变化,手术节段关节突关节退变CT分级增加.结论 椎间盘源性腰痛ADR术后5年手术节段仍保留一定的活动度,近侧相邻节段椎间盘和关节突关节退变缓慢,但手术节段关节突关节存在退变加速现象.
目的 探討椎間盤源性腰痛人工椎間盤置換術(artificial disc replacement,ADR)的中期療效.方法 2004年7月至2007年7月採用ADR治療椎間盤源性腰痛21例(24箇椎間盤),男9例,女12例;年齡26～67歲,平均46歲.均經椎間盤造影明確診斷.手術節段:L4-5例,L5S113例,L4-5+L5S13例.SB CharitéⅢ型椎間盤假體22箇,Activ L型椎間盤假體2箇.集中隨訪時行X線、CT和MR檢查,評估疼痛視覺模擬評分(visual analogue scale,VAS)及Oswestry功能障礙指數(Oswestry disability index,ODI).結果 隨訪時間4～7年,平均5.1年.(1)腰腿痛較術前明顯緩解,腰痛、腿痛VAS及ODI與術前比較差異均有統計學意義.(2)未齣現椎間盤假體脫齣、斷裂、塌陷及手術節段自髮性融閤.1例雙間隙手術者術後齣現腰椎輕度側凸,1例單間隙手術者齣現相鄰節段骨質增生加重.(3)手術節段椎間隙前緣高度較術前平均增加6.3 mm,後緣高度平均增加1.9 mm,節段性前凸角平均增加2.9°,椎間活動度平均為4.6°.近側相鄰節段椎間活動度平均減少2.5°.腰椎前凸角平均增加7.8°,腰椎屈伸活動範圍平均增加2.4°.(4)近側相鄰節段椎間盤退變MR分級及關節突關節退變CT分級無明顯變化,手術節段關節突關節退變CT分級增加.結論 椎間盤源性腰痛ADR術後5年手術節段仍保留一定的活動度,近側相鄰節段椎間盤和關節突關節退變緩慢,但手術節段關節突關節存在退變加速現象.
목적 탐토추간반원성요통인공추간반치환술(artificial disc replacement,ADR)적중기료효.방법 2004년7월지2007년7월채용ADR치료추간반원성요통21례(24개추간반),남9례,녀12례;년령26～67세,평균46세.균경추간반조영명학진단.수술절단:L4-5례,L5S113례,L4-5+L5S13례.SB CharitéⅢ형추간반가체22개,Activ L형추간반가체2개.집중수방시행X선、CT화MR검사,평고동통시각모의평분(visual analogue scale,VAS)급Oswestry공능장애지수(Oswestry disability index,ODI).결과 수방시간4～7년,평균5.1년.(1)요퇴통교술전명현완해,요통、퇴통VAS급ODI여술전비교차이균유통계학의의.(2)미출현추간반가체탈출、단렬、탑함급수술절단자발성융합.1례쌍간극수술자술후출현요추경도측철,1례단간극수술자출현상린절단골질증생가중.(3)수술절단추간극전연고도교술전평균증가6.3 mm,후연고도평균증가1.9 mm,절단성전철각평균증가2.9°,추간활동도평균위4.6°.근측상린절단추간활동도평균감소2.5°.요추전철각평균증가7.8°,요추굴신활동범위평균증가2.4°.(4)근측상린절단추간반퇴변MR분급급관절돌관절퇴변CT분급무명현변화,수술절단관절돌관절퇴변CT분급증가.결론 추간반원성요통ADR술후5년수술절단잉보류일정적활동도,근측상린절단추간반화관절돌관절퇴변완만,단수술절단관절돌관절존재퇴변가속현상.
Objective To evaluate the mid-term clinical and radiographic results of artificial disc replacement (ADR) for discogenic low back pain.Methods From July 2004 to July 2007,21 patients with discogenic low back pain,aged from 26 to 67 years,underwent lumbar ADR with the Charité Ⅲ artificial disc at 22 levels and Activ L prosthesis at 2 levels:L4-5 5 cases,L5S1 13 cases,L4-5 and L5S1 3 cases.The diagnosis was proved by discography in all the patients.The clinical and radiographic results were evaluated and compared between pre-,post-operation and finial follow-up.Results All patients were followed up for 4to 7 years (average,5.1 years).There were statistical differences between pre-operation and final follow-up in Oswestry disability index and Visual Analogue Scale for back pain and leg pain.All the prostheses were mobile without dislocation,breakage,subsidence or spontaneous fusion,only a slight scoliosis was noted in one patient.At the ADR levels,the anterior and posterior intervertebral height increased averagely 6.3 mm and 1.9 mm respectively,the lordosis increased 2.9°,and the mean range of motion (ROM) was 4.6°.At the adjacent level proximal to ADR,the intervertebral height and lordosis decreased slightly,and the ROM decreased 2.5°.The total lumbar lordosis increased 7.8°,and the total lumbar ROM increased 2.4°.According to MRI and CT scans,the degeneration of proximal adjacent disc and facet were not evident,however the degeneration of facets at the ADR levels was evident.Conclusion The 5 years results of ADR for discogenic low back pain were satisfactory,with preserved motion at the ADR level,and the degeneration of adjacent level was not evident.However,there was obvious degeneration in facet joints of the ADR level.
