人工髓核假体置换术治疗腰椎间盘突出症中期疗效评价

The midterm efficacy evaluation of artifical nucleus prosthesis replacement in treatment of lumbar disc herniation

目的评价人工髓核置换术治疗腰椎间盘突出症的中期临床效果。方法采用Raymedia公司提供的人工髓核假体（PDN），对20例腰椎间盘突出症患者施行后路PDN置换术。平均5．7（5．4～6．2）年随访，随访评价包括：临床疗效评分，x线、观察假体移位、软骨终板变化情况。结果随访末期临床评价优10例，良6例，尚可2例，差2例，优良率80％。1例因假体移位术后3个月取出。1例术后5年因相邻节段椎间盘突出症行腰椎融合手术。其余腰腿痛消失，恢复正常生活和工作。Oswestry功能障碍指数及VAS评分均明显改善。结论PDN置换术治疗腰椎间盘突出症中期效果肯定，但是中期主要并发症包括软骨终板损伤、假体下沉应引起足够重视。

Objective To evaluate the midterm efficacy of prosthetic disc nucleus（PDN） replacement for the treatment of lumbar disc herniation. Methods Twenty cases of lumbar disc herniation（ including one case of recurrent lumbar disc herniation） were treated with PDN. The twenty cases were followed-up 5.4 - 6.2 years（ mean 5.7 years）. Functional, and radiographic follow-up examinations, MRI and follow-up records of all patients were reviewed carefully. Results Clinical evaluation at the end of follow-up, there were 10 cases in excellent ,6 cases in good,2 ca- ses in fair and 2 cases in poor, and good rate was 80%. One patient accepted the revision operation to remove the PDN because of device migration. One patient accepted the fusion because of adjacent segment disease. The others experi- enced pain relief,and resumed their normal life and work. The average Oswestry score and VAS get better significantly. Conclusion The PDN was effective in treating patients with lumbar disc herniation. However, the medium term complications of device subsidence should be taken seriously.