人工椎间盘置换术后脊柱节段运动范围及有关参数变化的相关评价

背景由于生理老化和病理损害,常导致椎间盘破坏,而椎间盘是脊柱运动功能单位中最关键的结构,其破坏后不但可引起椎间盘退变性疾病,还将引起脊柱的生物力学紊乱,因此最好是重建椎间盘,即可治疗椎间盘疾病,又能部分恢复椎间盘的功能.目的探讨人工腰椎间盘置换术后腰椎间盘退变性疾病患者相应脊柱节段的运动范围及有关解剖参数的变化.设计前后对照研究.单位中山大学附属第三医院骨科、附属第二医院骨科.对象1999-02/2002-06中山大学附属二院确诊为腰椎间盘退变性疾病患者34例,41个椎间盘进行了人工椎间盘置换,术后均按要求完成了研究全过程.方法所有的患者均在气管内麻醉下行腹直肌旁切口经腹膜外入路进行人工腰椎间盘置换术,采用德国Link公司生产的SB ChariteⅢ型人工腰椎间盘,并进行相关评价.主要结局观察①患者术后的脊柱运动节段的稳定性、椎间关节的活动范围、椎间隙高度及椎间孔面积的变化.②术后的临床效果.结果单节段置换L3-4 2例,L4-5 18例,L5S1 7例;双节段置换L3～4和L4-51例,L4-5合并L5S1 6例.所有患者均进行了随访,时间3～38个月,平均随访时间18.6个月,总优良率90%.腰椎间盘突出伴腰椎不稳4例,术后腰椎动力位摄片证实手术节段椎体间无异常位移,重建了腰椎的稳定性.其余的手术节段未见不稳现象.手术后L4-5椎间的屈伸范围与对照组比较,差异无显著性意义(P＞0.05).仅对施行椎间盘置换的L4-5节段伴椎间隙Ⅰ～Ⅱ°狭窄的15例进行了测量,证明手术前后椎间盘高度和椎间孔面积差异有显著性意义(t=2.547,2.634,P＜0.05).结论对腰椎间盘源性疾病进行人工间盘置换,除能恢复腰椎节段的运动功能外,还可以重建椎间隙高度,扩大椎间孔面积,加大脊柱节段的运动范围.

Correlated evaluation on the spinal segment motion scope and the alteration of the corre sponding parameters after artificial lumbar intervertebral disc replacement

BACKGROUND: Intervertebral discs are often destroyed by physiological aging and pathological damages. The results may cause not only disc degenerative diseases, but also serial changes of spinal biomechanics because intervertebral discs are key structures in the spinal motion segment. So it is better to reconstruct the normal function of the destroyed disc, which not only can treat disc degenerative diseases but also restore its function partly.OBJECTIVE: To explore the motion scope and the alterations of the corresponding parameters of the corresponding spinal segment after artificial disc replacement(ADR) in patients with degenerative diseases of lumbar intervertebral disc.DESIGN: A before-after controlled study.SETTING: Department of Orthopaedics, the Third Affiliated Hospital and Department of Orthopaedics, the Second Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: The study was principally performed in the Department of Orthopaedics of the Second Affiliated Hospital of Sun Yat-sen University. Thirty-four patients diagnosed with degenerative diseases of lumbar intervertebral disc were selected for our study during February 1999 to June 2002. Artificial disc replacement was performed in 41 intervertebral discs. All patients completed the whole process of the study according to the postoperative requirement.METHODS: All the patients received ADR with SB Charite Ⅲ artificial lumbar intervertebral disc(AID) made by Link Company, Germany, made through an anterior extraperitoneal approach under endotracheal anaesthesia after pararectal incision, and relative evaluations as well.tor segment, motor scope of the intervertebral articulation, the height of inpostoperative clinical effectivenessRESULTS: Single segment replacement was performed in 2 cases of I3-44, 18cases of L4-5, and 7 cases of L6S1, and two-segment replacement was performed in 1 case of L3-4 combined with L4-5 and 6 cases of L4-5 combined with L6S1. All patients received postoperative follow-up for a period of 3 to 38 months(average of 18.6 months) with a total excellent or good ratio of 90%. No abnormal dislocation was found in 4 cases of lumbar disc herniation (LDH) with lumbar spinal instability by postoperative lumbar dynamic film, which proved that the operation reconstructed the lumbar stability. No instable segments were found in other operated cases. The postoperative extension and flexion scope of L4-5showed no significant difference compared with that of the control group(P＞ 0.05) . Measurement only performed in 15 cases of L4-5 segment ADR accompanied with Ⅰ- Ⅱ° stenosis in intervertebral space with the results proved that there were significant differences in the height of the intervertebral space and the size of the intervertebral foramen before and after operation( t =2. 547, 2. 634, P＜0.05).CONCLUSION: ADR for lumbar intervertebral disc-derived diseases can reconstruct the height of intervertebral space, enlarge the size of intervertebrai foramen, and to increase the motor scope of the spinal segments, except the restoration of the motor function of the lumbar segments.