人工腰椎间盘置换的临床应用：现状与未来

Clinical application of artificial lumbar disc replacement: Present and future

背景:人工腰椎间盘置换的基本理念是在稳定病变节段的前提下,力求最小影响相邻节段的生物力学状态,防止以及减少相邻节段退变的发生率。目的:分别对人工腰椎间盘置换的适应证和禁忌证、围置换期经济学考量、远期并发症以及人工腰椎间盘置换与融合术的混合使用效果进行了探讨。方法:计算机检索PubMed数据库、中国期刊全文数据库、中国生物医学文献数据库近十年的相关文献。纳入腰椎间盘置换术的回顾性和前瞻性临床实验报告,排除观点重复的文章,最后对34篇文献进行归纳与分析。结果与结论:1982年人工腰椎间盘假体首次临床应用以来,已有许多关于腰椎间盘置换的临床报道,然而对临床实验中遇到的许多问题始终没有统一答案。人工腰椎间盘置换的适应证和禁忌证应考虑到置换节段数对临床结果的影响、小关节退变对临床结果的影响、既往有腰椎间盘手术史患者的选择、患者年龄、椎间盘置换前休息时间等因素。评价腰椎间盘置换是否优于传统的腰椎融合,可以从椎间盘置换中出血量、手术时间、置换后住院时间等方面进行考量。腰椎间盘置换后较常见的并发症有异位骨化、植入物机械故障、相邻节段和小关节退变。将人工腰椎间盘置换与融合术的混合使用治疗多节段腰椎间盘病变,使两种手术干预方法互补不足,得到优于单独使用的手术疗效。

BACKGROUND： The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE： To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as well as the effect Of artificial lumbar disc replacement combined with fusion surgery. METHODS： The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total Of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION： Since the first artificial lumbar disc prosthesis designed to be commercially distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. H0we~/er, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. Theintraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone.