腰椎间盘人工髓核置换术后中期疗效分析

目的探讨人工髓核（prosthetic disc nucleus，PDN）置换术治疗腰椎间盘突出症的中期疗效，初步评价PDN置换术的实用价值。方法自2002年2月至8月采用单枚PDN假体置换术治疗单节段腰椎间盘突出症患者28例，术后随访48个月者22例。临床疗效评价内容包括：术后的主观症状改善情况、手术节段活动度、手术节段椎间隙高度变化，观察并统计手术并发症发生情况，并与同期行单纯髓核摘除术者进行对照研究。结果PDN组除2例假体脱出再次手术取出外，其余患者术后临床症状均明显缓解。Oswestry功能障碍指数显著改善，术前平均为53％，术后第24个月为15．5％，第36个月为16％，第48个月为15％。Prolo评分术前为4．3分，术后第48个月为8．7分。腰椎活动度术后第24个月平均为12．0°，第36个月为12．5°，第48个月为12．0°。手术节段椎间隙高度有不同程度地降低，较术前平均降低约18％。主要并发症包括：术后早期一过性腰痛18例，假体脱出2例，术后48个月随访时发现假体下沉12例，软骨终板损伤15例。术后临床疗效与单纯髓核摘除组比较大致相当。结论单枚PDN置换术治疗腰椎间盘突出症临床疗效肯定，能有效地保持腰椎功能，但仍不能有效地维持手术节殷椎阁隙高席．尚存存一此较为严重的并发痒．因此府严格掌握手术活席证．慎莺开展此项手术。     

腰椎间盘人工髓核置换术后手术节段活动度和椎间隙高度变化的观察

目的:探讨腰椎间盘人工髓核(prosthetic disc nucleus,PDN)置换术对维持手术节段腰椎活动度和椎间隙高度的作用。方法:自2002年2月至2003年11月采用单枚PDN置换术治疗单节段腰椎间盘突出症患者65例,将术后平均随访24、36、48个月的57例患者分为A组(23例)、B组(22例)、C组(12例),观察各组术后的主观症状、手术节段腰椎活动度(ROM)和手术节段椎间隙高度变化,并统计手术并发症情况。结果:除C组2例假体脱出,二次手术取出外,其余患者术后临床症状均明显缓解。A组术后第24个月手术节段平均ROM为15.2°,手术节段椎间隙高度较术前降低4.2%;B组术后第24个月平均ROM为13.5°,椎间隙高度较术前降低12%,第36个月平均ROM为13.2°,椎间隙高度较术前降低12%;C组术后第24个月平均ROM为13.0°,椎间隙高度较术前降低12%,第36个月平均ROM为13.0°,椎间高度较术前降低17%,第48个月平均ROM为13.2°,椎间高度较术前降低18%。结论:单枚PDN置换治疗腰椎间盘突出症可有效维持手术节段腰椎活动度,尚不能有效保持椎间隙高度。     

人工髓核置换术治疗腰椎间盘突出症

[目的]评价人工髓核假体（prosthetic disc nucleus，PDN）治疗腰椎间盘突出症的近期效果。[方法]2003年6—11月，对20例单节段腰椎间盘突出症施行PDN单枚置换术，并获得平均26．4（23—29）个月随访。[结果]1例术后因假体移位再次手术取出。其余19例患者术后临床症状均消失，运动功能明显改善，椎间隙高度较术前平均增加17．2％（P〈0．01）。其中1例手术椎间隙发生自融合。至随访末期Oswestry功能障碍指数及Prolo功能评分均明显改善。椎间隙高度增加值与临床评分改善值无相关性。[结论]PDN置换术能有效地治疗腰椎间盘突出症，并能恢复和维持退变椎间隙高度，近期效果肯定。过分强调术后椎间隙高度增加或许并不合适。     

人工髓核置换术治疗腰椎间盘突出症疗效分析(附19例随访报告)

目的评价人工髓核(PDN)置换治疗腰椎间盘突出症的效果。方法随访自2002年3～7月采用人工髓核置换术治疗腰椎间盘突出症患者19例,男12例,女7例,均为单间隙病变,手术节段为L_(4～5)11例,L_5S_1 8例,随访时间32～37个月,平均35．3个月。结果19例术后症状较术前均有不同程度减轻,2例出现假体移位,1例出现假体脱出,7例随访时手术节段椎间隙高度较术后出现不同程度丢失,2例出现终板塌陷。结论人工髓核置换治疗椎间盘突出症近期疗效满意,远期效果存在一些潜在并发症,在选择PDN置换还是椎间融合时应严格把握手术指征。     

双节段人工腰椎间盘置换术的疗效与探讨

[目的]观察采用以双段SB Charite Ⅲ人工椎间盘置换术治疗退变性腰椎间盘疾病的l临床结果并探讨其可行性。[方法]自2000年10月至2006年8月，对22例L4-S1退变的病例采用双节段人工腰椎间盘置换术，男16例，女6例；年龄43～54岁，平均48岁；均获得随访，随访时间10—61个月（平均37．4个月），分别于手术前后对患者的情况进行JOA评分和影像学对比。[结果]术后病例JOA评分较术前显著提高（P〈0．05）。按FRANKLE标准，JOA评分改善率1年后优12例，良7例，可3例；3年后共获得随访18例，其中优10例，良5例，可3例。术后X线片显示人工椎间盘位置正确，椎间隙高度恢复正常，椎间活动度得到维持。15例患者返回原工作，2例变换工作，1例退休。所有病例无假体功能并发症发生，无假体松动、半脱位、下沉。[结论]在严格适应证的前提下，双节段人工椎间盘置换术是可以获得满意临床疗效的，可在有条件的医院积极开展。     

人工髓核假体置换术治疗腰椎间盘突出症

目的 比较人工髓核假体（PDN）置换术和传统单纯髓核摘除术治疗腰椎间盘突出症的疗效,评价人工髓核假体置换术的实用价值。方法 施行人工髓核假体置换术18例,16例为单节段腰椎问盘突出症,2例为两节段腰椎间盘突出,均采用单枚PDN置人单个椎间盘间隙。对照组单纯髓核摘除术30例,22例为单节段腰椎间盘突出,8例为两节段腰椎间盘突出。观察两组病例的临床效果。结果 PDN组术后临床症状均消失,运动功能明显好转。6例获得9～22个月的随访,9例获得3～9个月的随访,椎间隙高度较手术前平均增加10．5％,无髓核假体移位突出,术后疗效明显优于单纯髓核摘除术组,两者相比差异有显著性（P〈0．01）。结论 PDN置换术既能恢复脊柱的节段稳定性,又保持脊柱节段的活动性,适当的假体设计与材料选择也能使椎间盘与椎体后柱的负荷获得再平衡,有广泛的应用前景。     

腰椎间盘人工髓核假体置换术临床应用初步报告

目的评价人工髓核假体(prostheticdiscnucleus,PDN)置换术治疗腰椎间盘突出症的近期效果。方法2002年3～6月,共施行PDN置换术20例,男13例,女7例,平均年龄38.4岁;均为单节段腰椎间盘突出症,其中L4-5 17例,L5S1 3例;病程6个月～10年,平均26.7个月。均采用单枚PDN置入,PR725型15例,PR925型1例,PR525型1例,PW725型2例,PW525型1例。结果所有患者术后临床症状均消失,运动功能明显改善。17例获得1～3个月随访,椎间隙高度较术前平均增加15.8%,差异有非常显著性意义(t=5.84,P<0.01), 无早期假体移位发生。术后早期并发症主要包括一过性腰部酸痛和低热。结论PDN置换术能有效恢复退行性椎间盘病变患者的椎间盘高度,近期效果肯定,多数国人适合置入单枚PR725型PDN。     

人工髓核置换术治疗腰椎间盘突出症的临床初步报告

目的 探讨应用人工髓核(prosthetic disc nucleus，PDN)置换术治疗腰椎间盘突出症的临床效果．方法 自2002年6月～2003年2月，临床应用人工髓核置换术治疗腰椎间盘突出症20例，男12例，女8例，年龄25～68岁．其中L4.5间隙15例，ksl间隙5例，全部采用单枚PDN置入，所选用的假体PR725型11例，PR925型4例．PW725型5例。结果 全部病例术后随访3个月～1年，假体脱位1例，椎间隙感染1例，余病例假体位置理想，临床腰腿痛症状均缓解。术后椎间隙高度较术前平均增加14．9％．结论 人工髓核置换术治疗腰椎间盘突出症近期效果理想，其操作简单，为临床治疗提供一种新方法。     

人工腰椎间盘置换26例6年疗效分析

[目的]对人工腰椎间盘置换术的疗效进行临床和影像学评价。[方法]自1998年9月～2007年12月,应用SBCharit啨Ⅲ型假体对29例患者施行人工腰椎间盘置换术,对其中获得平均6.9年(3～9年)随访的26例30个节段假体进行疗效评价分析。26例患者中,男25例,女1例;平均年龄44.2岁(38～59岁);腰椎间盘退变性病变3例,腰椎间盘退变合并腰椎间盘突出症21例,腰椎间盘突出术后复发2例。VAS疼痛评分术前平均9.1分,Oswes-ty功能评分术前平均46.4分。所有患者均在全身麻醉下经腹壁前路行人工腰椎间盘置换术。22例行单节段置换,其中L4、58例、L4、5,L5S116例;二节段4例,均为L4、5和L5S1。本组分别在术前和术后1、3、6、12个月及末次随访时进行疗效分析。[结果]疼痛VAS评分:术后1、3、6和12个月分别为3.7、3.2、3.0和2.5分,2年时2.3分,末次随访时2.0分;Oswesty功能评分:术后1个月27.7分,术后3年9.7分,末次随访时7.4分,活动度:末次随访时1例活动度减小(4°),其余患者均有活动度,平均5.6°。所有患者术后无假体移位、松动和下沉;1例患者术后尚满意,总满意率96%。[结论]人工腰椎间盘置换术是治疗腰椎间盘退变的有效方法。     

小切口人工股骨头置换术治疗高龄股骨颈骨折24例报告

[目的]探讨高龄股骨颈骨折人工股骨头置换术的疗效。[方法]采用外侧小切口入路人工股骨头置换术治疗24例高龄股骨颈骨折。[结果]经10个月以上随访21例，未出现感染、深静脉栓塞、关节脱位、假体松动及下沉等严重并发症，疗效满意。[结论]外侧小切口人工股骨头置换术具有创伤小、出血少、术后恢复快等优点，适合高龄股骨颈骨折患者。完善的术前准备、正确熟练的手术操作、恰当的功能锻炼是保证疗效，预防并发症发生的关键。更适合在基层医院开展。     

Artificial nucleus replacement: surgical and clinical experience

Objective: To assess long‐term clinical results of prosthetic disc nucleus (PDN) replacement for the treatment of lumbar disc herniation. Methods: Seventy‐two patients with lumbar disc herniation were implanted with a single PDN device from March 2002 to December 2003. Fifty‐eight (80.6%) patients attended clinical, functional, and radiographic follow‐up examinations for more than 48 months. Independent analysis was performed by careful review of the interviews, operative reports, preoperative and postoperative radiographs, and computed tomography scans or magnetic resonance imaging (MRI). Results: After implantation, a significant proportion of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, neurological weakness, Oswestry and Prolo scores, intervertebral disc height and lumbar mobility. Intervertebral disc height was not well maintained, compared with the preoperative height it decreased 18% (P < 0.001). Several complications were associated with the implantation of PDN, including transient low‐back pain, implant dislocation, malposition of the implant, damage to the end plates and subsidence of implant. Conclusion: The clinical data show that PDN is preferred and can effectively increase the range of lumbar motion in patients with lumbar disc herniation. However, this study only represents cases in our centre.     

Prosthetic disc nucleus (PDN) replacement for lumbar disc herniation: preliminary report with six months' follow-up

A clinical follow-up study was performed to evaluate lumbar disc nucleus replacement clinically and functionally. The objective was to assess the clinical efficacy of the prosthetic disc nucleus (PDN) for treatment of lumbar disc herniation. The PDN was designed to treat patients suffering from disc herniation and/or degeneration. Clinical trials for PDN were first conducted in 1996, and the results showed that the PDN device was effective in most of the patients who were implanted. These studies had been carried out with patients who were implanted with a pair of the devices. The main complication was device migration. Therefore, a follow-up study based on a single PDN device implantation was designed to evaluate its clinical result. Forty-five patients with lumbar disc herniation were implanted with one PDN device from March 2002 to December 2002. Thirty (66.7%) patients came to the clinical, functional, and radiographic 6-month follow-up examinations. Independent analysis was performed by careful review of the charts, operative notes, preoperative and postoperative radiographs, magnetic resonance images, and follow-up records of all patients. After implantation, significant proportions of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, lumbar mobility, neurologic weakness, Oswestry and Prolo scores, and intervertebral disc height. No difference in work status after PDN implantation could be detected. Compared with the preoperative height, the intervertebral disc had gained 19.7% (P < 0.001). Device migration, failure, and dislocation were not noticed in any patient. A few patients had minor complications such as transient low-grade fever. Clinically, a single PDN is preferred and can effectively increase the height of the intervertebral disc in patients with lumbar disc herniation. However, long-term follow-up of PDN implantation needs to be studied.     

Partial disc replacement with the PDN prosthetic disc nucleus device: early clinical results

The aim of this study was to evaluate the efficacy of the PDN prosthetic disc nucleus device for the treatment of chronic discogenic back pain caused by degenerative disc disease. Among the 48 patients who underwent nucleus replacement surgery from January 2001 through May 2002, 46 patients were followed >6 months. The mean Oswestry Disability Index score was 58.9% preoperatively, and it improved to 18% at the 1-year follow-up. Visual Analogue Pain Scale scores improved from a preoperative mean of 8.5 to 3.1 after 1 year. The mean Prolo Scale score also improved from 5.2 preoperatively to 7.2 at 1 year. Major complications included four cases of device migration, requiring revision surgery, and infection in one patient. According to MacNab's criteria, results were excellent in 5 patients (10.9%), good in 31 (67.4%), fair in 3 (6.5%), and poor in 7 (15.1%). The overall clinical success rate was 78.3%. Nucleus replacement with the PDN device seemed to be effective in treating patients with chronic discogenic back pain caused by degenerative disc disease.     

Preliminary clinical experience with the Bryan Cervical Disc Prosthesis

OBJECTIVE: The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by interbody fusion of the cervical spine has been widely postulated. Therefore, reconstruction of a failed intervertebral disc with a functional disc prosthesis should offer the same benefits as fusion while simultaneously providing motion and thereby protecting the adjacent level discs from the abnormal stresses associated with fusion. This study was designed to determine whether a new, functional intervertebral cervical disc prosthesis can provide relief from objective neurological symptoms and signs, improve the patient's ability to perform activities of daily living, decrease pain, and provide stability and normal range of motion. METHODS: We conducted a prospective, concurrently enrolled, multicenter trial of the Bryan Cervical Disc Prosthesis (Spinal Dynamics Corp., Mercer Island, WA) for the treatment of patients with single-level degenerative disc disease of the cervical spine. Patients with symptomatic cervical radiculopathy and/or myelopathy underwent implantation with the Bryan prosthesis after a standard anterior cervical discectomy. At scheduled follow-up periods, the effectiveness of the device was characterized by evaluating each patient's pain, neurological function, and range of motion at the implanted level. RESULTS: Analysis included data regarding 60 patients at 6 months with 30 of those patients at 1 year. Clinical success at 6 months and 1 year after implantation was 86 and 90%, respectively, exceeding the study's acceptance criteria of 85%. These results compare favorably with the short-term clinical outcomes associated with anterior cervical discectomy and fusion reported in the literature. At 1 year, there was no measurable subsidence of the devices (based on a measurement detection threshold of 2 mm). Evidence of anterior and/or posterior device migration was detected in one patient and suspected in a second patient. There was no evidence of spondylotic bridging at the implanted disc space. The measured range of motion in flexion-extension, as determined by an independent radiologist, ranged from 1 to 21 degrees (mean range of motion, 9 +/- 5 degrees). No devices have been explanted or surgically revised. CONCLUSION: Discectomy and implantation of the device alleviates neurological symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports normal range of motion. The procedure is safe and the patients recover quickly. Restrictive postoperative management is not necessary. However, only after long-term follow-up of at least 5 years will it become clear whether the device remains functional, thus confirming these early favorable results. In addition, the influence on adjacent motion segments can be assessed after at least 5 years of follow-up.     

人工髓核置换术治疗腰椎间盘突出症的临床初步报告

目的 介绍人工髓核置换术治疗腰椎间盘突出症的手术方法并评价其近期临床疗效。方法 自2002年3～4月采用人工髓核置换术治疗腰椎间盘突出症患者9例，男6例，女3例；年龄22～48岁，平均33.4岁；病史8个月～3．6年，平均18.4个月。均为单间隙病变，以单纯腰痛为主者2例，腰痛伴一侧下肢放射痛或双侧下肢放射痛以一侧为主者7例。手术节段为L4.5 6例，LsS1 3例；后侧入路8例，经腹膜后侧前方入路1例。随访12～13个月．平均12.3个月。根据症状改善情况和影像学资料评价手术效果。结果 手术时间45～120min，平均60min；术中出血50～150ml，平均120ml。术后4～5d戴腰围下地活动，术后6周去腰围恢复正常活动。根据Oswestry下腰痛和功能不利评分,临床成功率88.9％；复查X线片示术后和术前椎间隙高度百分比为128％。1例患者术后腰痛缓解不明显，第4d出现健侧下肢放射痛，经卧床、脱水治疗后缓解。2例随访时摄正侧位X线片示植入物轻度移位，未见腰椎生理弧度异常改变．腰椎活动度正常。未见植入髓核脱出、感染等并发症。结论 人工髓核置换术在改善症状的同时能够增加椎间高度，维持腰椎的正常运动功能，近期临床疗效满意。     

人工髓核置换术治疗腰椎问盘突出症的近期临床疗效观察

目的探讨人工髓核置换术治疗腰椎间盘突出症的近期临床应用效果。方法自2004年3月~2004年5月,笔者采用人工髓核置换术治疗腰椎间盘突出症25例,23例经标准后侧入路单枚PDN植入,1例经横突间入路单枚PDN植入,1例经腹膜后入路单枚PDN植入。术后随访6~18个月。结果1例术后1周出现剧烈腰痛,摄片示PDN位置好,给予卧床、镇痛、脱水治疗后缓解;1例术后4周出现腰腿痛,摄片示PDN部分移位于椎管,二次手术取出PDN行融合术后症状缓解;1例术后1个月PDN部分塌陷入椎体内,偶有腰痛,对症治疗,症状缓解。X线片复查手术后椎间隙高度平均增加3.34mm。腰椎各方活动基本正常,根据Oswestry下腰痛和功能不利评分,临床成功率84%,无感染等并发症。结论人工髓核置换术治疗腰椎间盘突出症在改善症状的同时能够增加椎间高度,保留腰椎的正常运动功能,为腰椎间盘突出症的手术治疗提供了一种新方法。     

杨氏椎间孔镜治疗腰椎间盘突出症的远期疗效

[目的]应用回顾性研究方法,探讨采用杨氏椎间孔镜( YESSTM)技术治疗腰椎间盘突出症的远期疗效.[方法] 2000年6月～2003年5月期间采用YESSTM系统治疗112例腰椎间盘突出症患者,81例(72.3％)获得至少60个月随访(60～127个月,平均71.7个月).男48例,女33例;年龄17～56岁,平均32.7岁.其中,椎孔型和椎间孔外型64例,后外侧突出型25例,中央型2例.33例合并神经根管狭窄的行椎间孔成形术.术前、术后2周和末次随访时分别对患者进行下肢疼痛的VAS评分;Nakai分级法评估治疗效果.[结果]所有患者手术均顺利完成,术中出血量30～120 ml,平均65 ml,手术时间35～140 min,平均70 min.无严重并发症,无椎间隙感染.5例(4.46％)术后无效,4例(3.35％)术后随访3～72个月复发,均再次行翻修术.14例(12.5％)术后出现一过性下肢疼痛加重,保守治疗后缓解.术前、术后2周和末次随访下肢疼痛的VAS评分分别为(7.4±2.1)、(2.4±0.81、(2.2±0.6).术后和末次随访评分较术前差异显著.Nakai分级法术后和末次随访的优良率分别为82.7％和77.7％,远期优良率无统计学差异.[结论]椎间孔镜YESSTM技术治疗腰椎间盘突出症能够获得良好的远期疗效.     

人工髓核置换术治疗腰椎间盘病变的中远期随访结果

目的 探讨人工髓核置换术治疗腰椎间盘病变的中远期疗效和影响因素.方法 回顾性分析2002年3月至2003年10月采用人工髓核置换术治疗的34例腰椎间盘病变患者的临床资料.其中椎间盘源性腰痛20例,腰椎间盘突出症14例;随访时间48～66个月,平均52.6个月.采用Oswestry功能障碍指数(ODI)评分和疼痛视觉模拟评分法(VAS)评估患者术后改善情况和中远期功能.术前ODI评分平均58.4%,VAS评分平均7.4分.对放射学资料进行手术节段活动度、手术节段椎间隙高度变化对比研究.结果 术后早期腰痛及下肢痛症状明显缓解,术后12个月ODI评分平均18.2%,VAS评分平均1.8分,椎间隙高度较术前平均增加17.6%,手术节段活动度平均为9.2°.末次随访时,患者下肢放射性疼痛缓解满意,18例患者下腰痛逐渐加重,ODI评分平均为31.2%,VAS评分平均为3.1分.椎间隙高度较术前平均下降13.5%,手术节段活动度平均为6.8°,植入物移位发生率73.5%(25/34),软骨终板退变损伤发生率64.7%(22/34).结论 人工髓核置换术尚不能达到长期维持手术节段椎间隙高度的目的 ,术后手术节段活动度逐渐减少,下腰痛逐渐加重影响其中远期疗效,明确术前诊断和严格手术指征非常重要.     

Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up

We reviewed patients with cervical disc prosthesis replacement for single-level cervical disc disease to evaluate its clinical effect and maintenance of cervical spine motion. Fifteen patients underwent Bryan artificial cervical disc replacement and were followed-up for at least 24 months. No neurological or vascular complications were observed during or after operation. JOA, VAS, and NDI scores showed statistical significant improvement in our follow-up. The procedure achieved an 87% (13/15) satisfactory rate at 24-month evaluations according to Odom's criteria. The range of motion (ROM) of the cervical spine, treated segment, adjacent segment, and functional spinal unit (FSU) decreased at early follow-up, but they recovered to the preoperative level at 12- and 24-month follow-up. Also, preoperative lordosis of the cervical spine and FSU were not only maintained but also even improved during the 24-month follow-up. No obvious degeneration of adjacent discs were found at MRI. There were no cases of prosthesis subsidence or extrusion. The cervical disc prosthesis showed a good clinical outcome; it also restored ROM of the cervical spine and reestablished cervical curvature in our 24-month follow-up. But to be sure of its long term effect, a longer follow-up is needed.