腰椎椎间盘人工髓核置换(附20例随访)

Artificial nucleus pulposus replacement in lumbar disc(Primary report of 20 cases)

目的 :观察腰椎间盘人工髓核置换的效果。方法和结果 :为了减少腰椎间盘突出症手术后的后遗症 ,我们设计了人工髓核置换的手术 ,临床已进行了 2 0例 ,除一例掉出来外 ,19例随访 2～ 7年 ,疗效优良 ,能够维持椎体间术前高度。髓核假体是椭圆形用硅橡胶制成。通过流行的后路椎间盘摘除手术进路 ,利用特制的注入器将假体注入椎间盘中央。因纤维环上切口小 ,假体恢复圆形后比切口大 ,不易掉出来 ,一例掉出来的原因和防止方法作了介绍。文中从生物力学和解剖生理学方面讨论了此手术的价值和恢复此椎间盘功能的可能性。此手术不扩大切口 ,不延长手术时间 ,不增加病人痛苦 ,不影响原来椎间盘摘除术疗效 ,易为术者和病者接受 ,有推广应用价值。

Objectives:To observe the effect of artifical nucleus polposus replacement in lumbar disc.Methods & Results:20 cases of nucleus pulposus prosthesis replacement were performed following extirpation of the herniated lumbar intervertebral disces in last 7 years.19 cases of prostheses were keep in the center of the disces and maintain the intervertebral space as high as preoperation.But 1 prosthesis was escaped to the posterior aspect of the lumbar canal.The cause of escape and its preventive method were described.The prothesis was made by silicon and injected into the intervertebral space with a special injector,through the ordinary dorsal approach after extirpation of the herniated lumbar disc.Conclusions:Long term follow up study of the implantation cases,the lumbar intervertebral space was maintained as high as preoperative and preserved the function of this disc anatomically or biomechanically.The technique of replacement was as usually as the extirpation of the herniated lumbar disc and easily accepted by the patients and surgeons.