椎间盘源性腰痛人工椎间盘置换术的中期随访研究

The mid-term follow-up results of artificial disc replacement for discogenic low back pain

目的探讨椎间盘源性腰痛人工椎间盘置换术（artificial disc replacement，ADR）的中期疗效。方法2004年7月至2007年7月采用ADR治疗椎间盘源性腰痛21例（24个椎间盘），男9例．女12例；年龄26-67岁，平均46岁。均经椎间盘造影明确诊断。手术节段：k5例，L5S1 13例，L4-5＋L5S1 3例。SB Charite Ⅲ型椎间盘假体22个，Activ L型椎间盘假体2个。集中随访时行X线、CT和MR检查，评估疼痛视觉模拟评分（visual analogue scale，VAS）及Oswesty功能障碍指数（Oswestry disability index，ODI）。结果随访时间4-7年，平均5．1年。（1）腰腿痛较术前明显缓解，腰痛、腿痛VAS及ODI与术前比较差异均有统计学意义。（2）未出现椎间盘假体脱出、断裂、塌陷及手术节段自发性融合。1例双间隙手术者术后出现腰椎轻度侧凸，1例单间隙手术者出现相邻节段骨质增生加重。（3）手术节段椎间隙前缘高度较术前平均增加6．3mm，后缘高度平均增加1．9mm，节段性前凸角平均增加2．9°，椎阃活动度平均为4．6°。近侧相邻节段椎间活动度平均减少2．5°。腰椎前凸角平均增加7．8°，腰椎屈伸活动范围平均增加2．4°。（4）近侧相邻节段椎间盘退变MR分级及关节突关节退变CT分级无明显变化．手术节段关节突关节退变CT分级增加。结论椎间盘源性腰痛ADR术后5年手术节段仍保留一定的活动度，近侧相邻节段椎间盘和关节突关节退变缓慢，但手术节段关节突关节存在退变加速现象。

Objective To evaluate the mid-term clinical and radiographic results of artificial disc replacement （ADR） for discogenic low back pain. Methods From July 2004 to July 2007, 21 patients with discogenic low back pain, aged from 26 to 67 years, underwent lumbar ADR with the Charit6 HI artificial disc at 22 levels and Activ L prosthesis at 2 levels： L,5 5 cases, L5S1 13 cases, L,5 and LsS1 3 cases. The diagnosis was proved by discography in all the patients. The clinical and radiographic results were evaluated and compared between pre-, post-operation and finial follow-up. Results All patients were followed up for 4 to 7 years （average, 5.1 years）. There were statistical differences between pre-operation and final follow-up in Oswestry disability index and Visual Analogue Scale for back pain and leg pain. All the prostheses were mobile without dislocation, breakage, subsidence or spontaneous fusion, only a slight scoliosis was noted in one patient. At the ADR levels, the anterior and posterior intervertebral height increased averagely 6.3 mm and 1.9 mm respectively, the lordosis increased 2.9°, and the mean range of motion （ROM） was 4.6°. At the adjacent level proximal to ADR, the intervertebral height and lordosis decreased slightly, and the ROM de- creased 2.5°. The total lumbar lordosis increased 7.8°, and the total lumbar ROM increased 2.4°. According to MRI and CT scans, the degeneration of proximal adjacent disc and facet were not evident, however the degeneration of facets at the ADR levels was evident. Conclusion The 5 years results of ADR for discogenic low back pain were satisfactory, with preserved motion at the ADR level, and the degeneration of adjacent level was not evident. However, there was obvious degeneration in facet joints of the ADR level.