中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
39期
2750-2754
,共5页
刘艳成%夏群%张继东%徐宝山%胡永成%吉宁%苗军%白剑强%韩岳%宁尚龙%杨强
劉豔成%夏群%張繼東%徐寶山%鬍永成%吉寧%苗軍%白劍彊%韓嶽%寧尚龍%楊彊
류염성%하군%장계동%서보산%호영성%길저%묘군%백검강%한악%저상룡%양강
椎间盘%人工器官%假体和植入物%腰痛
椎間盤%人工器官%假體和植入物%腰痛
추간반%인공기관%가체화식입물%요통
Intervertebral disc%Artificial organs%Prostheses and implants%Low back pain
目的 探讨SB Charité人工腰椎间盘放置位置对椎间活动度的影响及应对措施.方法 2004至2007年天津医院脊柱外科30例患者(共32个椎间盘)经椎间盘造影证实为椎间盘源性腰痛、行腰椎人工椎间盘置换术,年龄28～55岁,平均44岁;置换节段L4-5 9例,L5S1 19例,L4-5+L5S1 2例.临床预后评估采用术前和随访时ODI和VAS腰腿痛评分,影像学评价包括拍摄站立位腰椎正侧位和过伸过屈位片,测量侧位片手术节段椎间活动度和椎间高度.假体位置按McAfee方法分为3组,采用配对t检验比较Ⅰ～Ⅲ组术前与术后假体植入节段的活动度和临床ODI、VAS评分.结果 28例获得随访24～60个月,平均38个月;所有假体终板与椎体终板嵌合紧密,均未发生假体断裂、塌陷或移位,假体周围无明显异位骨化.术前与术后ODI:(70.3±9.2),(7.6±8.6);术前与术后VAS腰痛:(7.5±2.6),(0.7±0.7);术前与术后VAS腿痛:(4.8±2.7),(0.3±0.3).假体位置:Ⅰ组,位置优,17例;Ⅱ组,位置良,6例;Ⅲ组,位置差,5例.术前Ⅰ、Ⅱ、Ⅲ组手术节段椎间活动度(度):(9.7±2.8)、(10.3±1.2)、(10.1±2.4);术后相应为(6.7±3.8)、(4.2±3.5)、(3.5±3.6).术后各项临床评分明显较术前改善(P＜0.01),椎间高度得到重建(P＜0.05).椎间平均活动度较术前降低(P＜0.05),但表现为随假体位置改善而逐渐增大的趋势.结论 SB Charité TDR治疗椎间盘源性腰痛的中期疗效满意.假体位置对椎间活动度有一定影响.有效的临床对策可减少假体位置偏差.
目的 探討SB Charité人工腰椎間盤放置位置對椎間活動度的影響及應對措施.方法 2004至2007年天津醫院脊柱外科30例患者(共32箇椎間盤)經椎間盤造影證實為椎間盤源性腰痛、行腰椎人工椎間盤置換術,年齡28～55歲,平均44歲;置換節段L4-5 9例,L5S1 19例,L4-5+L5S1 2例.臨床預後評估採用術前和隨訪時ODI和VAS腰腿痛評分,影像學評價包括拍攝站立位腰椎正側位和過伸過屈位片,測量側位片手術節段椎間活動度和椎間高度.假體位置按McAfee方法分為3組,採用配對t檢驗比較Ⅰ～Ⅲ組術前與術後假體植入節段的活動度和臨床ODI、VAS評分.結果 28例穫得隨訪24～60箇月,平均38箇月;所有假體終闆與椎體終闆嵌閤緊密,均未髮生假體斷裂、塌陷或移位,假體週圍無明顯異位骨化.術前與術後ODI:(70.3±9.2),(7.6±8.6);術前與術後VAS腰痛:(7.5±2.6),(0.7±0.7);術前與術後VAS腿痛:(4.8±2.7),(0.3±0.3).假體位置:Ⅰ組,位置優,17例;Ⅱ組,位置良,6例;Ⅲ組,位置差,5例.術前Ⅰ、Ⅱ、Ⅲ組手術節段椎間活動度(度):(9.7±2.8)、(10.3±1.2)、(10.1±2.4);術後相應為(6.7±3.8)、(4.2±3.5)、(3.5±3.6).術後各項臨床評分明顯較術前改善(P＜0.01),椎間高度得到重建(P＜0.05).椎間平均活動度較術前降低(P＜0.05),但錶現為隨假體位置改善而逐漸增大的趨勢.結論 SB Charité TDR治療椎間盤源性腰痛的中期療效滿意.假體位置對椎間活動度有一定影響.有效的臨床對策可減少假體位置偏差.
목적 탐토SB Charité인공요추간반방치위치대추간활동도적영향급응대조시.방법 2004지2007년천진의원척주외과30례환자(공32개추간반)경추간반조영증실위추간반원성요통、행요추인공추간반치환술,년령28～55세,평균44세;치환절단L4-5 9례,L5S1 19례,L4-5+L5S1 2례.림상예후평고채용술전화수방시ODI화VAS요퇴통평분,영상학평개포괄박섭참립위요추정측위화과신과굴위편,측량측위편수술절단추간활동도화추간고도.가체위치안McAfee방법분위3조,채용배대t검험비교Ⅰ～Ⅲ조술전여술후가체식입절단적활동도화림상ODI、VAS평분.결과 28례획득수방24～60개월,평균38개월;소유가체종판여추체종판감합긴밀,균미발생가체단렬、탑함혹이위,가체주위무명현이위골화.술전여술후ODI:(70.3±9.2),(7.6±8.6);술전여술후VAS요통:(7.5±2.6),(0.7±0.7);술전여술후VAS퇴통:(4.8±2.7),(0.3±0.3).가체위치:Ⅰ조,위치우,17례;Ⅱ조,위치량,6례;Ⅲ조,위치차,5례.술전Ⅰ、Ⅱ、Ⅲ조수술절단추간활동도(도):(9.7±2.8)、(10.3±1.2)、(10.1±2.4);술후상응위(6.7±3.8)、(4.2±3.5)、(3.5±3.6).술후각항림상평분명현교술전개선(P＜0.01),추간고도득도중건(P＜0.05).추간평균활동도교술전강저(P＜0.05),단표현위수가체위치개선이축점증대적추세.결론 SB Charité TDR치료추간반원성요통적중기료효만의.가체위치대추간활동도유일정영향.유효적림상대책가감소가체위치편차.
Objective To discuss the effect of SB Charité lumbar artificial disc position on intervertebral range of motion(ROM)and clinical management.Methods Between 2004 and 2007, 30 discogenic low back pain patients confirmed by discography underwent 1/2-level total disc replacement (TDR)implantation with 32 prostheses.There were 12 males and 18 females with a mean age of 44 years old (range:28-55).All indexed levels were inserted between L4-S1 involving L4-5(n =9), L5S1(n = 19)and L4-S1(n =2).The clinical outcome was measured by Oswestry disability index(ODI)and visual analogue scale(VAS).Radiographic outcome measures included flexion/extension ROM, restoration of operative level intervertebral disc height, maintenance of disc height at the final follow-up.A technique previously described by McAfee was used to evaluate TDR position in three groups.Paired t test was used to compare the preoperative and postoperative ROM and clinical ODI, VAS scores.Results Twenty-eight patients were followed-up for 24-60 months with an average of 38 months.All the prostheses were solidly immobilized with the vertebral endplate.No disc prosthesis rupture, dislocation, subsidence or heterotopic ossification was observed.Preoperative ODI, VAS back pain and VAS leg pain scores were 70.34 ± 9.21, 7.46 ± 2.65,4.81 ± 2.75;and postoperative corresponding scores 7.65 ± 8.61, 0.68 ± 0.69, 0.35 ± 0.32respectively.The positions of disc prostheses were graded as Group Ⅰ , excellent, n = 17;Group Ⅱ,suboptimal, n = 6;Group Ⅲ, poor, n = 5.Preoperative mean intervertebral flexion/extension ROM (degree)of Group Ⅰ to Group Ⅲ were 9.75 ± 2.80, 10.30 ± 1.20 and 10.08 ± 2.43 respectively.The postoperative mean intervertebral flexion/extension ROM(degree): 6.68 ± 3.83, 4.22 ± 3.51 and 3.48 ± 3.56 respectively.Postoperatively all clinical outcome scores were lower than preoperative ones.Disc height was significantly restored.Mean intervertebral ROM decreased versus preoperative.Although there was a tendency of mean intervertebral ROM increasing with a better disc position, no statistical difference was observed.Conclusion The mid-term clinical outcome of TDR is generally satisfactory.The TDR position influences intervertebral ROM to some extent.Efficient clinical management can reduce prosthetic malposition.
