颈椎间盘人工髓核置换

Nucleus pulposus prosthesis replacement in cervical spine

目的 探讨颈椎人工髓核置换的可行性。方法 颈椎前路用环锯法摘出有病变的椎间盘骨心 ,在骨心间剔除病变的髓核 ,置入人工髓核 ,再将此已置入人工髓核的椎间盘骨心植回到椎体间钻孔内。本组自 1989年到 1999年共施行 35例 ,6 7个椎间盘 ,通过 2～ 9年随访 ,结果 35例中一例外伤颈椎骨折脱位伴截瘫 ,术后手功能有进步。其余 34例是脊髓型颈椎病和混合型颈椎病 ,术后症状缓解 ,均属优良。随访 X片上人工髓核可以保持椎间盘高度 ,但三年后 X线片上有5 0 %左右椎体前有骨痂 ,此椎节失去运动度 ,但患者仍满意。结论 颈椎人工髓核置换的疗效和流行的椎间盘摘除植骨融合疗效一样 ,手术时不用取髂骨 ,少一个切口 ,减少了病人痛苦 ,手术时间至少缩短半小时 ,故此手术是可行的 。

Objective To evaluate the effectiveness of the replacement of nucleus pulposus prosthesis in cervical spine.Methods 35 cases of cervical myelopathy,and 67 cases were treated with anterior approach,and extirpated the pathogenic disc with trepanation,the bony disc cylinder was extirpated from the pathogenic intervertebral spaces,The degenerated nucleus pulposus in the center of cylinder was extracted but protected the anulus fibrosus and end plate.Then the prosthesis was inserted into the center of the bony cylinder.Prosthesis was made by silicon,14mm×7mm in size,and 3 5mm in high,The bony disc cylinder,including the prosthesis,was replaced into the original intervertebral space.Results The symptom of myelopathy was much improved and all patients stood the surgery well,after 2 9 years follow up.On X ray examination,the operative intervertebral space can maintain as high as preoperative,but about 50% of the patients had bony callus on the operative area of the cervical spine anteriorly.Conclusion The resulte of replacement of nucleus pulposus prosthesis of cervical spine after trepanation was as excellent as usually bone graft,but omited the incision on the patient's iliac and reduce the operative time.It is a good tcehnique and graceful to the surgens and patients.