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.

The mid- or long-term clinical results of prosthetic disc nucleus replacement in the treatment of lumbar disc disease

OBJECTIVE: To evaluate the mid- or long-term clinical results and the factors that influence the outcomes of prosthetic disc nucleus (PDN) replacement in the treatment of lumbar disc disease. METHODS: Thirty-four patients who underwent the PDN replacement from March 2002 to October 2003 were followed for an average of 52.6 months (range from 48 to 66 months). Twenty patients were discogenic low back pain, 14 patients were lumbar disc herniation. The follow-up results were evaluated by using the Oswestry disability index (ODI) and the visual analogue scales (VAS) through direct examinations and questionnaires. ODI was 58.4% preoperatively, and VAS was 7.4. Radiography was also used to measure the range of motion (ROM) and disc height of the operative segment, and findings were compared with those on preoperative radiographs. RESULTS: Twelve months after operation, a significant proportion of patients recovered from low back pain or leg pain, ODI decreased to averaged 18.2%. VAS decreased to 1.8, the average increase of the postoperative disc height was 17.6%, ROM was 9.2 degrees. At the final followup, all patients with deteriorated leg radicular sympotoms improved, ODI increased from 18.2% 12 months after operation to averaged 31.2%. Low back pain became more serious in 18 patients. VAS increased from 1.8 to 3.1, the average decrease of the postoperative to preoperative disc height was 13.5%, ROM decreased to 6.8 degrees. The rate of degeneration or breakages of the end plates was 64.7% (22/34), implant device migrations were observed in 25 patients. CONCLUSIONS: The mid- or long-term outcome of PDN replacement in the treatment of degenerative lumbar disc disease is not as encouraging as that of the short-term follow-up. It is neither effective in term of restoration of the intervertebral disc height nor increase of the ROM of the operative segment, complication rates are significantly higher, and inferior results are to be expected. The selection of suitable surgical candidates and determination of valid indications for operative treatment are very important.