人工全椎间盘置换治疗腰椎退行性疾病的疗效及安全性

Efficacy and safety of artificial total disc replacement in the treatment of lumbar degenerative diseases

背景:目前临床上广泛应用于治疗腰椎退行性疾病的腰椎融合常引起腰椎僵硬和邻近节段退化加速,全椎间盘置换等非融合术是避免上述问题出现的修复方法,但关于其应用价值与适应证等方面存在争议。目的:探讨人工全椎间盘置换治疗腰椎退行性疾病的有效性和安全性。方法:纳入南充市中心医院收治的自愿接受手术治疗的腰椎退行性疾病患者97例,按修复方式分为2组。融合组55例接受腰椎融合,置换组42例接受人工全椎间盘置换,术后随访6年。比较2组患者手术前后疼痛目测类比评分、Oswestry功能障碍指数及并发症的发生率。结果与结论:(1)2组间术前一般资料、腰腿痛目测类比评分和Oswestry功能障碍指数差异无显著性意义(P>0.05);(2)置换组手术时间、术后住院时间短于融合组,术中出血量小于融合组(P<0.01);(3)术后2组目测类比评分、Oswestry功能障碍指数较术前降低(P<0.01);置换组术后6个月及1年的目测类比评分和Oswestry功能障碍指数较融合组降低(P<0.01);(4)置换组术后并发症发生率2%低于融合组5%(P<0.05);(5)结果表明,人工全椎间盘置换治疗腰椎退变性疾病能够有效缓解腰腿疼痛及改善腰椎功能,具有较好的中长期疗效。

BACKGROUND： At present, lumbar fusion, which is widely used in the treatment of lumbar degenerative diseases, usually leads to lumbar stiffness and acceleration of adjacent segment degeneration. Non fusion, such as total disc replacement, is an effective way to avoid these problems, but there are some disputes about the value and indications. OBJECTIVE： To evaluate the efficacy and safety of total disc replacement in the treatment of lumbar degenerative diseases. METHODS： Totally 97 cases of degenerative diseases of the lumbar spine were treated by surgical treatment, and they were divided into 2 groups according to the operation methods. 55 cases underwent lumbar fusion surgery in the fusion group and 42 cases underwent artificial total disc replacement in the replacement group. All patients were followed up for 6 years. The Visual Analogue Scale（VAS） score, Oswestry Dysfunction Index（ODI）, and the incidence of complication were compared between the two groups before and after the operation. RESULTS AND CONCLUSION：（1） There were no significant differences in general information, VAS score, and ODI between the two groups before operation（P 0.05）.（2） The operation time and postoperative hospital stay in the replacement group were significantly shorter than that in the fusion group, and the amount of bleeding during operation was significantly lower in the replacement group than that in the fusion group（P 0.01）.（3） The scores of VAS and ODI in two groups were significantly lower after operation than those before operation（P 0.01）. The VAS score and ODI in the replacement group were significantly lower than that in the fusion group at postoperative 6 months and 1 year after operation（P 0.01）.（4） The incidence of complications in the replacement group（2%） was significantly lower than that in the fusion group（5%）（P 0.05）.（5） In conclusion, artificial total disc replacement for the treatment of degenerative lumbar disease can effectively relieve the pain of lumbago and leg, improve the lumbar function and have better medium-term and long-term effects.