Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

Purpose

Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease.

Materials and Methods

Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery.

Results

VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded.

Conclusion

Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.     

Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty

PurposeThe purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty.Materials and MethodsA total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up.ResultsThe mean follow-up period was 38 months (range, 25–114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis.ConclusionCDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.     

保留解剖及生物力学特点在人工颈间盘置换中的作用

目的探讨Mobi-C颈椎人工椎间盘置换治疗单节段退变性颈椎病的近期效果。方法对应用Mobi C颈椎人工椎间盘置换治疗的17例单节段颈椎间盘突出症患者于术前术后、术后1年级末次随访时进行全面的影像学和临床评价。结果病例随访1.5~3.4年,平均2.2年。Odom临床疗效评价术后1年优13例,良3例,可1例;末次随访优14例,良2例,可1例。患者的颈肩痛及上肢疼痛明显缓解,颈椎功能障碍指数（NDI）和SF-36生活质量量表评分明显改善,且差异有统计学意义（P〈0.05）,患者的生活质量明显提高。除2例患者发生异位骨化外,未发现相邻节段退变加速。1例患者因适应症掌握失误出现术后症状反复。结论保留颈椎生理特点的Mobi-C颈椎人工椎间盘置换对单阶段退变性颈椎病的患者近期疗效确切,可明显提高患者的生活质量。     

人工颈椎间盘的假体结构及应用特点

背景：目前人工颈椎间盘假体设计和使用都得到了很大的发展,主要有低磨擦滑动面、弹簧系统、橡胶制成的人工颈椎间盘及其他各种弹性假体。 目的：总结人工颈椎间盘假体结构特点及在骨科的应用现状。 方法：由第一作者以“人工颈椎间盘;假体;椎间盘突出症”和“Artificial Cervical Disc;prosthesis ; intervertebral disc herniation;the surgical therapy”为关键词,分别在CNKI(2000至2013年)和PubMed数据库(1960至2013年)http://www.ncbi.nlm.nih.gov/PubMed)检索近年文献,检索内容为人工颈椎间盘假体在骨科的应用。计算机在CNKI数据库检索出200篇文献,在PubMed数据库检索出56篇文献,阅读标题和摘要进行筛选,保留符合纳入标准的40篇归纳总结。 结果与结论：人工颈椎间盘假体类似椎间盘生理功能,材料具有耐磨损、耐疲劳、抗腐蚀等特点,它类似于人体椎间盘的生理和生物力学载荷功能,保持了脊柱的稳定和运动功能,避免了邻近节段的退变加速。文章重点对Bryan、Mobi-C、PCM、Prodisc-C、Prestige及CerviCore人工颈椎间盘结构做了介绍。人工颈椎间盘置换的短期疗效已得到认可,但是它不能完全替代颈前路植骨融合内固定,是治疗颈椎退变性椎间盘疾病的又一主要手段。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访

背景：Bryan人工颈椎间盘置换的短期疗效优良已被大多数学者公认,但有关其中长期临床效果及并发症的资料较少。 目的：总结Bryan人工颈椎间盘置换治疗颈椎病的中期临床效果。 方法：选择2004-11/2007-12在四川大学华西医院骨科接受Bryan人工颈椎间盘置换的颈椎间盘突出症患者34例,其中单节段置换30例,双节段置换4例。于置换前、置换后7 d、3,6,12,24,36,48个月行SF-36生活质量量表评分、JOA评分、颈部及上肢疼痛目测类比评分;以颈椎正侧位及功能位X射线片测量手术节段、邻近节段及C2~7屈伸活动度的变化,手术节段和邻近节段椎间高度变化及手术节段的轴向平移情况。 结果与结论：所有患者置换后神经症状均明显好转,各随访点SF-36生活质量量表躯体评分和心理评分、JOA评分、颈部和上肢疼痛目测类比评分较置换前明显改善(P < 0.05),3个月之后各随访时点两两比较差异无显著性意义(P  > 0.05)。置入的Bryan假体历次随访均保留了>2°的活动度,未发现手术节段异位骨化与自发性融合,随访48个月时手术节段及C2~7屈伸活动度较置换前略有增加,但差异无显著性意义(P > 0.05);上下邻近节段屈伸活动度维持了置换前水平;手术节段的椎间高度由置换前的(6.04±1.02) mm增加到(8.44±0.43) mm(P  < 0.05);上下邻近节段椎间高度及手术节段的轴向平移均维持了置换前水平。说明Bryan人工颈椎间盘治疗颈椎间盘退变性疾病的中期临床效果良好,较好的保留了手术节段、邻近节段及整个颈椎的运动学特性,且近中期并发症很少。     

人工颈椎间盘假体置换短期随访：颈椎稳定性及其运动范围变化

背景：椎间盘摘除减压后的节段融合会限制节段的生理运动,造成邻近节段应力加大而导致其退变加速。 目的：观察人工颈椎间盘植入假体治疗颈椎病短期随访中的稳定性及置换节段和颈椎整个节段的运动范围变化。 方法：于2010-06/2011-08在常州市第二人民医院骨科共施行PCM钴铬合金颈椎间盘假体置换11例12个节段,男7例,女4例;脊髓型颈椎病8例,外伤性颈椎间盘突出3例。 结果与结论：患者随访时间为3~12个月。置换后1,3,6个月以及末次随访时置换节段过屈过伸活动度、左右侧屈活动度与术前接近。置换后1个月、末次随访时患者日本矫形外科协会评分明显升高,而Oswestry颈椎功能障碍指数明显降低(P < 0.05),且末次随访时日本矫形外科协会评分和Oswestry颈椎功能障碍指数与术后1个月时差异无显著性意义(P > 0.05),同时X射线未发现假体松动、下沉或异位骨化等不良反应。提示PCM人工颈椎间盘置换后短期颈椎稳定功能活动效果较好。 关键词：钴铬合金颈椎间盘假体;颈椎病;人工颈椎间盘置换;临床效果;医学植入物;组织工程 doi:10.3969/j.issn.1673-8225.2012.09.008     

颈椎连续三节段 Hybrid 手术与融合术的生物力学研究

目的 比较颈椎连续三节段Hybrid手术[颈前路减压植骨融合(anterior cervical discectomy and fusion, ACDF)+人工颈椎间盘置换(cervical disc arthroplasty, CDA)]与三节段ACDF对颈椎生物力学的影响。方法 基于CT数据建立C1～T1颈胸椎有限元模型,通过植入Prestige LP和Zero-P假体模拟3种模型,包括两种Hybrid模型(AFA:C3～4、C5～6节段植入Prestige LP,C4～5节段植入Zero-P;FAF:C3～4、C5～6节段植入Zero-P,C4～5节段植入Prestige LP)和三节段ACDF模型(FFF)。比较各模型前屈、后伸、侧弯以及轴向旋转时相邻节段及整体活动范围(range of motion, ROM)以及相邻节段椎间盘内压力(intradiscal pressure, IDP)及小关节接触力(facet contact force, FCF)的变化。结果 AFA模型相邻节段及整体ROM都更接近完整模型,FAF、FFF模型相邻节段ROM最大增幅分别为15.0%和23....     

腰椎棘突间动态稳定装置治疗腰椎间盘退变性疾病的中期疗效观察

目的观察腰椎棘突问动态稳定装置（Wallis系统）治疗腰椎退变性疾病的中期疗效。方法回顾性分析2008年2月至2010年10月应用第二代Wallis系统治疗34例腰椎退变性疾病患者的中期疗效。通过比较患者术前、术后3月和末次随访的疼痛视觉视觉模拟量表评分、下腰痛日本骨科协会评分,计算JOA改善率评估手术疗效;通过腰椎侧位X线片测量手术节段椎间盘平均高度及腰椎动力位X线片测量病变相邻节段椎体问活动范围的变化,评价腰椎稳定性的变化。结果31例患者经26～38个月随访,VAS评分末次随访较术前有显著下降（P〈0．05）,较术后3个月无明显改变（P〉0．05）;JOA评分末次随访较术前有显著上升（P〈0．05）,较术后3个月无明显改变（P〉0．05）。DH值及ROM值末次随访较术前和术后3个月均无明显改变（P〉0．05）。结论Wallis系统治疗椎间盘退变性疾病能缓解症状、延缓置入节段高度丢失和维持椎间稳定。     

单侧、双侧内固定联合经椎间孔椎间融合对腰椎术后假关节形成及腰椎活动的影响

目的:探讨后路单侧、双侧内固定联合经椎间孔椎间融合术(TLIF)治疗单节段腰椎退行性病变术后假关节的发生及其对腰椎活动的影响。方法:回顾性队列研究。纳入2009年1月—2015年5月徐州市中心医院121例腰椎退行性病变患者的临床资料,其中男45例、女76例,年龄40~70(50.8±6.8)岁。根据手术方式的不同分为两...     

Discover人工颈椎间盘置换术后异位骨化的临床研究

目的　分析Discover人工颈椎间盘置换术治疗颈椎病的异位骨化形成原因及防治对策。 方法 回顾性分析23例应用Discover人工颈椎间盘置换术治疗的颈椎病患者。 在术前、术后1周及末次随访时的颈椎X线片上测量置换节段矢状位、冠状位活动度,并根据McAfee分级法判断末次随访时置换节段的异位骨化情况。 结果 术后患者23例患者均获随访,时间27~36个月。末次随访置换节段矢状位活动范围（5.5±2.2）°;冠状位左右侧屈活动范围分别为（3.4±1.2）°和（3.6 ±0.8）°。共有5例患者在末次随访时出现置换节段假体周围异位骨化,发生率21.7%。 结论 DISCOVER人工颈椎间盘置换术治疗颈椎病存在一定的异位骨化发生率,与文献报道相符,术者应有意识地预防异位骨化的发生以避免置换节段的活动度丢失。     

观察IntraSPINE椎板间动态稳定系统治疗腰椎退行性疾病近期疗效及适应证探讨

目的 观察IntraSPINE椎板间动态稳定系统治疗腰椎退行性疾病的近期疗效,探讨其适应证。方法分析2017年2月 ～ 2018年3月28例采用IntraSPINE椎板间动态稳定系统治疗腰椎退行性疾病的手术疗效及近期随访结果（术后1周、3个月、6个月、12个月）,采用疼痛视觉模拟评分（visual analogue score,VAS）、日常生活能力评分（oswestry disability index,ODI）、Odom’s评分及患者满意度评价近期手术疗效,测量分析术前、术后手术节段椎间隙高度比及活动度,对比术前与术后腰椎整体活动度变化。结果 术后随访15 ～ 27个月,所有患者术后症状均得到不同程度缓解。术后各时间段VAS评分、ODI评分与术前比显著改善,差异有统计学意义（P<0.01）,末次随访Odom’s评分优24例,良3例,可1例,优良率为96.4%。手术节段活动度（range of motion,ROM）术前,术后1周、3个月、6个月、12个月分别为6.6°±2.4°、6.3°±2.4°、6.9°±2.1°、7.1°±1.8°、7.0°±1.6°,术前与术后手术节段活动度差异无统计学意义（P>0.05）;术前与术后12个月腰椎整体活动度分别为31.5°±4.7°、32.7°±4.8°,差异无统计学意义（P>0.05）。术后1周椎间隙高度比明显增加,与术前相比差异有统计学意义（P<0.05）,3个月后椎间隙高度比逐渐减小至平稳水平,但仍然大于术前。本组患者未出现严重并发症,总体满意度为96.4%。结论 IntraSPINE椎板间动态稳定系统操作简便,手术时间短,出血量少,无棘突骨折等植入物相关并发症,近期疗效确切,中长期临床疗效还需大样本、多中心观察评价。     

半限制型人工颈椎间盘置换与植骨融合术后下颈椎生物力学的有限元分析

目的 研究Discover、Prodisc-C人工椎间盘置换术与植骨融合术后下颈椎活动度（range of motion, ROM）、椎间盘应力、韧带张力的生物力学特性以及植入假体力学性能的改变。方法 建立C5~6椎间盘退变3种手术方案：Discover、Prodisc-C人工椎间盘置换和自体髂骨植骨融合有限元模型,同时建立C4~7节段下颈椎原始模型。分析术后下颈椎C4~7节段在矢状面、冠状面及横断面上椎体的生物力学特性变化。结果 术后手术节段关节ROM变化：Discover模型增加12.7%~73.1%,Prodisc-C模型增加74%~98%,植骨融合模型下降55.8%~71.8%。Discover置换后上邻近椎间盘应力无明显增加,下邻近椎间盘应力在前屈、后伸、轴向旋转工况下减少33.2%~54.2%,囊韧带张力增幅比Prodisc-C置换后减少30%~40%。Discover假体最大应力（36.72 MPa）出现在前屈工况下,小于Prodisc-C假体的最大应力（42.66 MPa）。结论 人工椎间盘置换术可以保留手术节段的运动性能,Discover作为新一代人工椎间盘假体,在减少韧带负担和维持脊柱稳定性方面有所进步。研究结果可为颈椎前路融合手术和人工颈椎间盘置换术的临床研究提供理论依据。     

人工腰椎间盘置换治疗退行性腰椎间盘疾病16例分析*☆○

背景：与传统的单纯腰椎间盘切除和脊柱融合治疗方法相比,人工腰椎间盘置换具有明显的理论优势,已成为治疗退行性腰椎间盘疾病的最有希望的方法。 目的：总结人工腰椎间盘置换治疗退行性腰椎间盘疾病的初步临床疗效。 方法：2007-05/2010-10行人工腰椎间盘置换治疗退行性腰椎间盘疾病16例,其中男9例,女7例,平均年龄40.5岁(28~55岁)。 结果与结论：随访时间6~36个月,置换后目测类比评分、Oswestry功能障碍指数、椎间隙高度均较置换前有显著改善(P < 0.01)。置换后腰椎活动度获有效维持,置换后腰椎活动度与置换前比较差异无显著性意义(P > 0.05)。结果显示人工腰椎间盘置换治疗退行性腰椎间盘疾病的初步临床结果令人满意,但其远期效果尚待进一步观察。     

Smith-Robinson技术切除后纵韧带并金属植入物内固定治疗单节段 颈椎间盘突出症

背景：Smith-Robinson技术结合金属植入物内固定已广泛用于治疗单节段颈椎间盘症,但是否切除后纵韧带仍有争议。 目的：观察Smith-Robinson技术切除后纵韧带并金属植入物内固定治疗单节段颈椎间盘突出症的疗效。 方法：回顾性分析2005/2008天津医科大学总医院骨科Smith-Robinson技术切除后纵韧带,使用Cage植骨融合、钛板螺钉置入内固定治疗的45例单节段颈椎间盘突出患者的临床资料。 结果与结论：治疗后随访12~36个月,随访12个月时JOA评分较治疗前明显提高(P < 0.05),目测类比疼痛评分较治疗前明显降低(P < 0.05),Cobb角、椎间隙高度较治疗前明显改善(P > 0.05),最终融合率100%,未出现Cage移位。疗效评价,30例优,13例良,2例可,无症状加重者,末次随访优良率95.6%。说明通过Smith-Robinson技术切除后纵韧带即能够实现对脊髓、神经根的彻底减压,又能有效防止椎间隙坍陷、成角畸形等并发症。     

椎间孔镜导棒滑移结合偏心环锯技术治疗L5/S1腰椎间盘突出症的疗效分析

目的探讨椎间孔镜导棒滑移结合偏心环锯技术治疗L₅/S₁腰椎间盘突出症的临床疗效。方法选取29例采用椎间孔镜导棒滑移结合偏心环锯技术治疗的L₅/S₁节段腰椎间盘突出症患者,通过手术前后各时间点的视觉疼痛模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及末次随访时改良Macnab标准评估其临床治疗效果。结果29例患者均顺利完成手术,未出现神经根损伤、硬膜撕裂等严重并发症。术后2 d、3个月及末次随访时的VAS评分及ODI均较术前降低,差异有统计学意义(P<0.05);末次随访手术效果优15例,良11例,可3例,优良率为89.66%。结论椎间孔镜导棒滑移结合偏心环锯技术治疗L₅/S₁节段腰椎间盘突出症手术疗效满意。     

人工颈椎间盘置换术后异位骨化三维有限元模型的建立与意义

目的建立包含完整下颈椎(C_3-C_7)的C_(5/6)节段人工颈椎间盘置换(cervical disc replacement,CDR)术后异位骨化(heterotopic ossification,HO)三维有限元模型,为CDR术后HO生物力学相关研究提供基础模型。方法将健康志愿者颈椎CT的DICOM格式数据依次使用Mimics 16.0、Geomagic 12.0及Pro/Engineer 5.0软件构建包含C_3-C_7颈椎的C_(5/6)节段CDR术后HO三维有限元模型,并观察HO对手术节段活动度和小关节压力的影响。结果本研究建立了CDR术后HO三维有限元模型,共包含394 198个单元和765 411个节点。运动加载结果显示HO发生后手术节段活动度有不同程度的下降,曲伸、侧弯及旋转活动较无HO模型减少分别20.6%、14.3%及11.3%;手术节段后方小关节应力在HO发生后在不同工况下有不同程度的下降,后伸、左侧弯、右侧弯、左旋转及旋转活动较无HO模型减少分别4.1%、3.7%、10.7%、26%及12.1%。结论本研究成功构建了包含C_3-C_7下颈椎的C_(5/6)节段CDR术后HO三维有限元模型,为CDR术后HO的生物力学相关研究提供了基础模型。     

K-Rod动态稳定系统治疗腰椎退行性疾病的中期疗效

目的 探讨K-Rod动态稳定系统治疗腰椎退行性疾病的中期疗效及其对邻近上位节段的影响。方法 回顾性分析昆明市第一人民医院骨科2011年2月至2013年6月65例采用K-Rod动态稳定系统治疗腰椎退行性疾病患者的临床资料。其中，男31例，女34例，年龄21 ～ 73岁，平均（53.4±10.8）岁；融合组（n=21），非融合组（n=20），“融合+非融合”组（n=24）。记录术中失血量、手术时间、住院时间及并发症；根据术前及各随访时间腰痛、下肢痛VAS评分，ODI评分评价临床疗效。比较3组病例术前及随访时间腰椎侧位X线片、腰椎MRI手术及邻近上位节段椎间隙高度、椎间盘退变Pfirrmann''s分级情况。结果 经72 ～ 84个月，平均（72.0±8.6）个月随访。3组组内术后3、6个月及末次随访时腰痛、下肢痛VAS评分及ODI评分与术前比较，差异均有统计学意义（P<0.05）。末次随访时，腰痛、下肢痛VAS评分改善率，融合组为66.4%、76.7%，非融合组为84.4%、72.4%，“融合+非融合”组为70.8%、77.8%；邻近上位节段椎间盘退变Pfirrmann''s分级：非融合组、“融合+非融合”组与术前比较差异无统计学意义（P>0.05），融合组与术前比较差异有统计学意义（P<0.05）。手术节段椎间高度指数: 3组组内术后1周与术前比较，差异有统计学意义（P<0.05），术后3个月、6个月、末次随访时与术后1周比较差异无统计学意义（P>0.05）。邻近节段椎间高度指数：非融合组、“融合+非融合”组术后1周、3个月、6个月、末次随访时与术前比较，差异无统计学意义（P>0.05）；融合组末次随访与术前比较，差异有统计学意义（P<0.05）。结论 应用K-Rod动态稳定系统对腰椎退行性疾病行非融合及“非融合+融合”术治疗，中期随访疗效良好，一定程度上可延缓邻近节段椎间盘退变，对退变的椎间盘有一定的保护作用。     

Salvage revision total knee replacement using the Endo-Model rotating hinge prosthesis

Inability to balance a knee in complex revision total knee replacement has led to the use of rotating hinged knee devices in these cases as a salvage procedure.

We conducted a retrospective study of 50 patients receiving 51 Endo-Model® rotating hinge prosthesis with an average follow-up of 4 years (range 2–6 years). Clinical and radiological results were reviewed at latest follow-up. Five patients died from unrelated causes. Reasons for revision were infection (23), aseptic loosening (23), implant failure (3), stiffness (1) and peri-prosthetic fracture (1). The average number of previous surgery from and including the primary arthroplasty was three (ranges 1–14). Seven patients required plastic surgery for soft tissue cover.

There was notable improvement in the pain, stability, range of motion and mobility of the patients with an improvement in the Hospital for Special Surgery Score (35.9 to 72.17). Postoperatively, 11 (22%) had an excellent HSS grade, 22 (44%) good grade, 10 (19%) fair grade and 8 (15%) poor grade. A significant number of our patients had an extremely low preoperative HSS score, and for these patients, an improvement to a fair grade HSS score was a satisfactory and realistic outcome. Forty-four (86%) patients were satisfied with the outcome of the revision surgery, 3 (6%) noncommittal and 4 (8%) disappointed. Comparing revision for infection vs. aseptic loosening, 22 (95%) patients out of 23 were satisfied in the aseptic loosening group vs. 17 (74%) out of 23 were satisfied in the infected group.

In selected complex cases, salvage revision surgery shows encouraging results in the short to medium term using the Endo-Model® rotating hinge prosthesis. A knee score such as the Hospital for Special Surgery score (objective outcome) should be used in conjunction with a patient satisfaction questionnaire (subjective outcome) in assessing the clinical outcome of complex, salvage revision knee surgery. Revision for infected total knee replacement is less likely to produce a satisfactory outcome as compared to revision for aseptic loosening.     

经皮椎间孔镜靶向穿刺技术治疗单节段腰椎间盘突出症的体会

目的探讨经皮椎间孔镜靶向穿刺技术治疗单节段腰椎间盘突出症的临床疗效。方法选择2014年5月~2016年6月在泰州市中医院行经皮椎间孔镜治疗的单节段腰椎间盘突出症患者70例,根据术前、术后1天、术后3个月及末次随访患者VAS评分和ODI指数评价疗效。改良Macnab疗效评定标准评价临床疗效。结果术后VAS和ODI评分均较术前降低,术后1天、术后3个月及末次随访与术前相比较,差异均具有统计学意义(P0.05),末次随访时根据MacNab标准评分优54例,良10例,可6例,优良率91.4%。结论经皮椎间孔镜靶向穿刺技术治疗单节段腰椎间盘突出症近期疗效满意,是一种安全、有效的微创术式。     

Minimally invasive lateral unicompartmental knee replacement: Early results from an independent center using the Oxford fixed lateral prosthesis

PurposeThe aim of the present study was to assess clinical outcome as well as short-term survivorship of fixed-bearing lateral unicompartmental knee replacement (UKR) from a non-designer centre using the Oxford Fixed Lateral prosthesis.MethodsThis single-centre retrospective cohort study reports the short-term results of 51 consecutive patients (52 knees) after fixed-bearing lateral UKR with a minimum follow-up of one year. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), objective American Knee Society Score (AKSS-O), range-of-motion (ROM), visual analog scale for pain (VAS), Tegner activity score and UCLA score.ResultsThere was no revision surgery, defined as exchange of at least one of the components resulting in a survival rate of 100% at two years. Three patients required further surgical treatment resulting in a survival rate of 94.2% (95% confidence interval (CI): 83.2–98.1%) with the endpoint ‘any reoperation’. Outcome scores, VAS and ROM showed a statistically significant improvement at final follow-up (P < .001). The OKS improved from 26.4 ± 6.9 (12–41) preoperatively to 39.7 ± 8.4 (15–48), the AKSS-O from 54.3 ± 15.3 (18–90) to 82.2 ± 15.6 (40–100), the American Knee Society Functional Score from 56.4 ± 21.3 (10–100) to 83.1 ± 20.2 (five to 100) and the ROM from 123.5 ± 13.5 (90–140) to 134 ± 10.3 (95–150).ConclusionEarly results of fixed-bearing lateral UKR using the Oxford-Fixed-Lateral prosthesis were encouraging with a significant improvement in pain and knee function as well as an excellent survivorship of 100% at a mean follow-up of two years. Further follow-up is necessary to evaluate the long-term effectiveness of this device and the surgical technique.Level of EvidenceLevel IV, retrospective cohort study.