人工腰椎间盘置换对维持腰椎活动度和椎间隙高度的作用

The role of artificial disc replacement in restoring lumbar segment motion and intervertebral height

目的 观察人工腰椎间盘置换对维持腰椎活动度和手术间隙高度的作用。方法 随访自1998年4月至2003年4月我院及经作者手术的数家医院应用SBCharitéⅢ型人工椎间盘假体行椎间盘置换术共75例86个间隙。将术后平均随访时间达2、3、5年的病例分别设为A组(32例)、B组(27例)、C组(19例),比较3组在术后第2、3、5年的手术节段活动度(ROM)和椎间隙高度(IH)变化,进行组内比较,并统计所有病例的手术并发症。结果 A组在第2年的平均ROM为15度, 平均IH为14. 1mm;B组在第2年的平均ROM为14. 2度, 平均IH为13 .8mm; 在第3年的平均ROM为13 .7度,平均IH为13. 4mm;C组在第2年的平均ROM为9. 1度,平均IH为11 .5mm;在第3年的平均ROM为8. 8度,平均IH为11 .0mm;在第5年的平均ROM为8 .0度,平均IH为10 .5mm。组内比较无显著性差异。术后发现射精延时和粘连性肠梗阻各1例,经保守和手术治疗治愈。另发现3例假体下沉,C组中3例纤维环钙化, 1例滑动核磨损标记环断裂, 1例上盖板与滑动核轻度前移,但均未引起症状。结论 人工腰椎间盘置换术可以有效维持手术节段的活动度和椎间隙高度。

Objective To investigate the role of artificial disc replacement (ADR) in resto ring lumbar segment motion and intervertebral height (IH). Methods Seventy-five patients with intervertebral disc diseases underwent ar tificial disc replacement and were divided into 3 groups to be followed up for 2 years (group A, n=32), 3 years (group B, n=27), and 5 years (group C, n=19) respectively. Before the operation and during the follow-up the range of motion (ROM) of the involved lumbar segments and IH were assessed. Results The mean ROM and IH of the group A were 15 degrees and 14.1 mm respec tively during the follow-up 2 years after operation. The mean ROM and IH of the group B were 14.2 degrees and 13.8 mm respectively during the follow-up 2 year s after the operation and 13.7 degrees and 13.4 mm respectively during the follo w-up 3 years after operation. The mean ROM and IH of the group C were 9.1 degre es and 11.5 mm respectively during the follow-up 2 years after the operation an d 8.8 degrees and 11.0 mm respectively during the follow-up 3 years after opera tion, and 8.0 degrees and 10.3 mm respectively during the follow-up 5 years aft er operation. No significant differences in ROM and IH were found among differen t groups at any time point (all P>0.05). Malposition was found in immediatel y after operation in 11 patients, all of the group C. During the follow-up, 3 c ases of prostheses subsidence and 3 cases of annular ossification were found. No severe complications appeared. Conclusion ADR is effective in restoring the ROM and IH of vertebrae suffering f rom intervertebral disc diseases.