CAJ | 학술논문

目的：探讨腰椎Activ L人工椎间盘置换术后的影像学表现与临床疗效的相关性。方法：2009年3月~2012年3月，应用Activ L假体对32例腰椎间盘退变性疾患的患者进行人工椎间盘置换术，其中30例患者共36个假体获得12~46个月（平均28.8个月）的随访，随访2年以上者20例（其中随访3年以上15例）。均在术前和末次随访时进行腰、腿痛VAS评分和Oswestry功能障碍指数（ODI）评分，同时测量手术节段和上、下相邻节段的活动度、椎间隙高度及腰椎前凸角。对术前及末次随访时的VAS评分、ODI评分，手术节段和上下相邻节段的活动度、椎间隙高度以及腰椎前凸角分别进行配对t检验，分别以每例患者末次随访时的VAS评分和ODI评分为应变量，以末次随访时的活动度、椎间隙高度以及腰椎前凸角为自变量，进行相关性分析。结果：末次随访时的腰痛VAS评分、腿痛VAS评分和ODI评分与术前比较均有显著改善（P＜0.0001）。末次随访时，手术节段、上位相邻节段活动度明显增加（P＜0.05），而下位相邻节段活动度无明显变化（P＞0.05）；手术节段及其上、下相邻节段椎间隙高度与术前比较均无明显变化（P＞0.05）；腰椎前凸角与术前比较无明显变化（P＞0.05）。末次随访时，手术节段、上下相邻节段的活动度和椎间隙高度及腰椎前凸角与VAS评分和ODI评分均无明显相关性（r＜0.2138，P＞0.05）。结论：腰椎Activ L人工椎间盘置换术治疗腰椎间盘退变性疾患的近中期疗效满意，近中期随访时手术节段、上下位相邻节段的活动度和椎间隙高度与临床疗效无明显相关性。
목적：탐토요추Activ L인공추간반치환술후적영상학표현여림상료효적상관성。방법：2009년3월~2012년3월，응용Activ L가체대32례요추간반퇴변성질환적환자진행인공추간반치환술，기중30례환자공36개가체획득12~46개월（평균28.8개월）적수방，수방2년이상자20례（기중수방3년이상15례）。균재술전화말차수방시진행요、퇴통VAS평분화Oswestry공능장애지수（ODI）평분，동시측량수술절단화상、하상린절단적활동도、추간극고도급요추전철각。대술전급말차수방시적VAS평분、ODI평분，수술절단화상하상린절단적활동도、추간극고도이급요추전철각분별진행배대t검험，분별이매례환자말차수방시적VAS평분화ODI평분위응변량，이말차수방시적활동도、추간극고도이급요추전철각위자변량，진행상관성분석。결과：말차수방시적요통VAS평분、퇴통VAS평분화ODI평분여술전비교균유현저개선（P＜0.0001）。말차수방시，수술절단、상위상린절단활동도명현증가（P＜0.05），이하위상린절단활동도무명현변화（P＞0.05）；수술절단급기상、하상린절단추간극고도여술전비교균무명현변화（P＞0.05）；요추전철각여술전비교무명현변화（P＞0.05）。말차수방시，수술절단、상하상린절단적활동도화추간극고도급요추전철각여VAS평분화ODI평분균무명현상관성（r＜0.2138，P＞0.05）。결론：요추Activ L인공추간반치환술치료요추간반퇴변성질환적근중기료효만의，근중기수방시수술절단、상하위상린절단적활동도화추간극고도여림상료효무명현상관성。
Objectives: To correlate the radiographic results of patients undergoing Activ L total disc repal-cement with clinical outcomes. Methods: From March 2009 to March 2012, 32 patients with degenerative disc disease(DDD) underwent Activ L total disc repalcement, 30 cases(36 prosthesis) of whom received an av-erage follow-up of 28.8 months(range, 12-46 months), 20 of whom with a 2-years follow-up and 15 with a 3-years follow-up. Clinical parameters as visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated preoperatively and at the final follow-up. Radiographic parameters such as range of motion (ROM), intervertebral disc height(IDH) of the index and adjacent segments, and lumbar lordosis were recorded. Preop-erative VAS score, ODI score, ROM, IDH and lumbar lordosis were compared with those at postoperation by using paired t test. The correlation between ROM, IDH and lumbar lordosis were reviewed. Results: The VAS (back pain), VAS (leg pain) and ODI score improved significantly at final follow-up ( P<0.0001). At final follow-up, ROM of the index level and the upper adjacent level showed increase significantly(P<0.05), while the lower adjacent level remained unchange(P>0.05). IDH of the index level showed no significant increase at the final follow-up(P>0.05) compared with that before surgery. The IDH of the upper and lower adjacent level showed no significant difference at final follow-up(P>0.05). Compared with preoperative data, the lumbar lor-dosis showed no obvious difference at final follow-up(P>0.05). At final follow-up, the radiographic parameters were not correlated with clinical results (r<0.2138, P>0.05). Conclusions: The short and mid-term results of Activ L prosthesis for degenerative disc diseases are satisfying, and radiographic parameters as ROM, IDH and lumbar lordosis are not correlated with clinical results.