人工髓核置换术治疗腰椎间盘突出症

Treatment of lumbar disc herniation by prosthetic disc nucleus replacement

[目的]评价人工髓核假体（prosthetic disc nucleus，PDN）治疗腰椎间盘突出症的近期效果。[方法]2003年6—11月，对20例单节段腰椎间盘突出症施行PDN单枚置换术，并获得平均26．4（23—29）个月随访。[结果]1例术后因假体移位再次手术取出。其余19例患者术后临床症状均消失，运动功能明显改善，椎间隙高度较术前平均增加17．2％（P〈0．01）。其中1例手术椎间隙发生自融合。至随访末期Oswestry功能障碍指数及Prolo功能评分均明显改善。椎间隙高度增加值与临床评分改善值无相关性。[结论]PDN置换术能有效地治疗腰椎间盘突出症，并能恢复和维持退变椎间隙高度，近期效果肯定。过分强调术后椎间隙高度增加或许并不合适。

[ Objective] To evaluate short term clinic results of prosthetic disc nucleus （PDN） replacement for the treatment of lumbar disc herniation. [ Method ] Twenty cases of lumbar disc herniation （ including one case of recurrent lumbar disc herniation） were treated with PDN from June 2003 to November 2003, including 13 males and 7 females with average age of 40. 5 years. All cases were implanted with a single PDN, in which 7 cases with PR725, 8 cases with PW725, and 5 cases with PDN-SOLO-7 respectively. [ Result] After surgery, one patient accepted the revision operation to remove the PDN because of device migration, the others experienced pain relief. The nineteen cases were followed-up for 23 - 29 months （ mean 26. 4 months）. Compared with preoperative height of intervertebral disc, it gained increase of 17.2% （P 〈0.01 ） and migrations of PDN were no longer found. An intervertebral self-fusion was found in one of the nineteen patients and the complication associated with PDN replacement was not reported in other literatures. The average Oswestry score droped from a preoperative rating of 86. 8% to a rating of 6. 0%, and the mean Prolo score increased from 2. 9 to 8.6. The variations of disc height had no correlation with that of ODI and Prolo Score. [ Conclusion] The PDN device has proven to be effective in treating lowback pain and increase the heights of intervertebral disc in patients with lumbar disc herniation and its short result is encouraging. The complication of self-fusion in affected disc space might happen after the operation of PDN replacement. Overemphasizing increase of disc height might not be appropriate. The long term result of PDN implantation need to be studied.