腰椎间盘人工髓核置换术并发症原因分析及预防策略(附4年随访报告)

Assay and counter measure for the complications of the prosthetic disc nucleus-pulposus(PDN)replacement

[目的]探讨腰椎间盘人工髓核置换术早、中期并发症原因及预防策略。[方法]2002年2月～2004年8月采用单枚人工髓核假体（prosthetic disc nucleus-pulposus，PDN）置换术治疗腰椎间盘突出症患者80例，其中65例获得24～48个月随访（平均36个月），男45例，女20例；平均35．2岁。病程6个月～10年。其中L3,4 1例，L4、5 ，35例，L5S1 29例。将术后平均随访时间达24、36、48个月的65例分别分为A组（30例）、B组（23例）、C组（12例）。随访评价包括：临床疗效评分，X线、MRI检查并测量椎间隙高度，观察假体移位，软骨终板变化情况。[结果]主要并发症包括：术后3d内即出现一过性腰痛24例，1—3个月发生假体脱出3例。24个月～48个月随访时观察到软骨终板损伤39例，假体下沉32例。A组术后第24个月椎间高度较术前降低约4％；B组术后第36个月椎间高度较术前降低约12％；C组术后第48个月椎间高度较术前降低约18％。[结论]单枚PDN假体置换治疗腰椎间盘突出症主要并发症：早期假体脱出，中、远期并发症包括软骨终板损伤、假体下沉。因此，应慎重开展此项手术，严格把握手术适应证。

[ Objective] To analyze the reasons and counter treatment of complication after prosthetic disc nucleus implantation, [ Method ] From Feb 2002 to Aug 2004, 80 patients of lumbar disc herniation were implanted with one single PDN device at our centre, 65 patients of them came to the clinical, functional, and radiographic follow-up examinations, magnetic resonance images and follow-up records of all patients were reviewed carefully. They were divided into three groups. Group A： 30 ca- ses had at least 24 months follow-up data. Group B： 23 cases had at least 36 months follow-up data. Group C： 12 cases had at least 48 months follow-up data. [ Result ] After implantation, device migrations were noticed in 3 patients. 24 cases experienced low back pain. In 24 - 48 month follow-up, the MR images of 39 patients had shown the abnormal signal pattern of the endplate where PDN-solo was implanted, even 32 of them had been found subsidence. In Group A, the height of intervertebral disc at the 24 month follow-up was decreased 4%. In Group B, at 36 month follow-up, it was decreased 12%. In Group C, at 48 month follow-up, it was decreased 18%. [Condusion] After follow-up, the clinical effect of PDN is preferred. However, the complications of device dislocation, device subsidence remain problems that must be highlighted. This study suggested that the complications of PDN are serious. Therefore, the proper selecting patients for PDN replacement are crucial for good results. The indications for PDN must be restricted.