人工髓核置换术治疗退变性腰椎间盘病的近期效果

PDN replacement for the treatment of degenerative disc disease

目的:评价人工髓核置换术治疗退变性腰椎间盘疾病的近期效果.方法:2002年1月至2003年6月,对单节段退变性腰椎间盘病患者施行人工髓核置换术21例,男15例,女6例,平均年龄39.1岁;均为单节段退变性腰椎间盘疾病,其中L4～55例,L5S116例;病程4个月～10年,平均26个月.19例经后侧手术入路,2例经腰大肌的前外侧入路;均采用单枚PDN置入:PR725型4例,PR925型1例,PW525型2例,PW725型14例.结果:所有患者均获得随访,平均14个月.患者术后临床症状、运动功能明显改善,椎间隙高度增加.Oswestry疼痛功能指数评分由术前61%改善为术后1年的17%,VAS评分则由8.2分降为2.8分.早期有2例假体发生移位,引起神经受压症状而再次手术.临床优良率达90.5%.结论:人工髓核PDN置换术能有效地治疗退变性腰椎间盘病,近期效果满意.

Objective: To evaluate the efficacy of the PDN (prosthetic disc nucleus ) replacement for the treatment of degenerative disc disease. Methods: Twenty-one patients underwent nucleus replacement surgery from January 2001 to June 2003, including 15 males and 6 females with average age of 39.1 years old. Five patients in L4-5 and 16 in L5S1. Nineteen patients were operated through the posterior approach, and two with the ALPA technique. Each patient was implanted with a single PDN: 4 cases with PR725, 1 case with PR925,2 cases with PW525, and 14 cases with PW725 respectively. Results: All patients were followed up for 6 to 22 months (average 14 months). Seventeen of the 21 patients were followed up for over 1 year. All patients experienced pain relief and got very good functional improvement. The heights of the intervertebral space increased after surgery .The mean Oswestry Disability Index score was 61% preoperatively, and improved to 17% at the 1-year follow-up. The mean Visual Analogue Pain Scale scores improved from 8.6 preoperatively to 2.8 after 1 year. Major complications included 2 cases of device migration, requiring revision surgery. According to MacNab's criteria, results were excellent in 8 patients (38.1%), good in 11 (52.4%) and poor in 2 patients (9.5%). The overall clinical success rate was 90.5%. Conclusions: Partial Disc Replacement with the PDN device was effective in treating patients with chronic discogenic back pain caused by degenerative disc disease in short term follow-up.