人工腰椎间盘置换术中期疗效分析

目的 对人工腰椎间盘置换术的中期疗效进行评价分析.方法 1999年12月至2006年12月应用Charité SBⅢ假体对65例患者施行人工椎间盘置换术,对其中获得平均5.8年(2～7.5年)随访的48例52个假体进行疗效评价分析.48例患者中,男性22例,女性26例,平均年龄43岁(36～58岁);椎间盘退变9例,椎间盘退变合并椎间盘突出34例,椎间盘突出术后复发5例.VAS疼痛评分术前平均9.3分,Oswestry功能评分术前平均45.8分.所有患者均在全身麻醉下经前路行人工椎间盘置换术.44例患者行单间隙椎间盘置换,其中L3,43例,L4,523例,L5～S118例;双节段4例,其中L3,4和L4,51例,L4,5和L5～S13例.分别在术前和术后1、3、6、12、24个月和末次随访时进行疗效评定.结果 疼痛视觉模拟评分:术后1、3、6、12、24个月分别为4.3、4.3、3.8、3.1、2.6分,末次随访时1.8分;Oswestry功能评分:术后1个月28.6分,术后24个月12.5分,末次随访时8.2分;活动度:末次随访时仅1例患者丧失活动度,其余患者保留活动度,平均5.5°.所有患者术后无假体移位、松动及下沉;1例患者对手术不满意.总满意率为98%.结论 人工椎间盘置换术是治疗腰椎间盘退变的有效方法之一,其远期疗效有待进一步观察.

Total lumbar disc replacement with SB Charité Ⅲ prosthesis: Chinese experience with more than two years follow-up

Objective To evaluate the clinical and radiographic results of total lumbar disc replacement with SB Charité Ⅲ prosthesis.Methods From Dec 1999 to Dec 2006,total lumbar disc replacement with SB Charité Ⅲ prosthesis was performed in 65 patients affected with degenerative lumbar disc disorders.Among these patients，48(52 prosthesis)were followed up for more than two years(from 2.0 to 7.5 years).There were 22 males and 26 females with an average age of 43 years old(from 36 to 58 years).The diagnosis was lumbar disc herniation with low back pain in 34 patients，discogenic low back pain in 9 patients and failed lumbar disc surgery in 5 patients.All patients underwent standard anterior procedure under general anesthesia.One level replacement was done in 44 patients(L3，4 in 3，L4，5 in 23 and L5-S1 in 18)，and two level procedures in 4 patients(L3,4/L4,5 in 1 and L4,5/L5-S1 in 3).Clinical and radiographic results of these patients were evaluated at each follow-up time(1，3，6，12，24 months after operation and the latest).Results The average visual analogue scales score for pain was 9.3 before operation，changed to 4.3 one month after operation，further declined to 2.6 two years after operation and finally to 1.8 at the latest follow-up evaluation.Meanwhile，the average Oswestry Disability Index was 45.8 before operation，28.6 one month after operation，12.5 two years after operation and 8.2 at the latest followup evaluation.All operated levels but one maintained mobile and there was no significant loss of range of motion observed.Complications such as implant dislocation or significant subsidence of the prosthesis occurred in none case of this group.All patients but one(98％)were satisfied with the surgery at the latest follow-up evaluation.Conclusions Total lumbar disc replacement is an effective method for the treatment of degenerative disc disorders.Its long-term outcome remains to be verified.