人工髓核置换术治疗腰椎间盘突出症的近期疗效观察

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 2005年3月—2007年5月,我们采用人工髓核置换术治疗腰椎间盘突症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X线片示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X线片示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3.134mm。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。

CLINICAL EFFECTIVENESS OF PROSTHETIC DISC NUCLEUS REPLACEMENT IN TREATMENT OF LUMBAR DISC HERNIATION

Objective To investigate clinical effectiveness of prosthetic disc nucleus （PDN） replacement in the treatment of lumbar disc herniation. Methods 25 patients with lumbar disc herination were treated with PDN replacement from March 2005 to May 2007. The standard posterior approach was used in 23 patients. The intertransverse process approach was used in 1 patients and the lateroanterior retroperitoneal approach was employed in 1 patient. All patients were implanted with a single PDN. All patients were followed up 6 to 18 months （average 1214 months）. Results 1 patient had a bad recovery with low back pain after one week. The position of PDN was correct in the X-ray. The symptoms disappeared after treatment. The displacement of PDN into the spinal canal was observed in 1 patient with low back pain associated with radicular leg pain after four weeks and the symptoms disappeared after the second operation. The PDN was partially collapsed into the vertebral body after one month in one patient causing slight low back pain. Based on oswestry low back pain and disability scores,the clinical successful rate was 84 %. No infection occurred. Conclusion PDN replacement can improve clinical symptoms,increase disc height and restore the normal lumbar motion as well as. Its clinical effectiveness is excellent in short-term observation.