人工腰椎间盘置换术的发展历史及研究现状

Development history and research status of lumbar artificial disc replacement

慢性腰痛的治疗方法目前尚有争议,腰椎融合术已经成为治疗由椎间盘退变引起的明显慢性下腰痛的标准方法;然而腰椎融合术可能会损伤脊柱的正常生理和生物力学功能,固定节段的活动度降低会引起邻近节段受压增加,从而导致受累节段的退变。因此人工椎间盘置换术被作为预防邻近节段退变的治疗手段之一,得到快速发展。

In lumbar artificial disc replacement, the affected disc is replaced with an artificial disc, which has the potential to maintain normal segmental motion and may thus reduce the risk of adjacent segment degeneration. However, the long-term stability, endurance and strength of the prosthesis are unknown for the majority of implants. There have been many different methods of classification in the lumbar artificial discs. lumbar artificial discs can be classified as ball-and-socket design and viscoelasticity design according to movement pattern; or classified as constrained, semi-constrained or unconstrained by restriction on the degree of freedom, and so forth. Mo M（ metal-onmetal） devices are theoretically designed to achieve lower volumetric wear（ mainly as a result of lower friction） in comparison to traditional Mo P（ metal-on-polyethylen） designs, thereby potentially reducing local inflammation and osteolysis. Mobile bearing devices provide higher degrees of freedom than fixed bearing devices. Mechanical properties of one-plate design are close to those reported in the literature for the normal disk. Three-dimensional fabric discs and tissue engineered discs may provide another options. However, they are still in the trial phase with gaps remain to be clinically applied.