腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效分析

The mid- and long-term follow-up of total disc replacement for lumbar intervertebral disc degenerative diseases

中文关键词:  腰椎间盘退变性疾病  人工椎间盘置换术  临床疗效

英文关键词:Lumbar intervertebral disc degenerative diseases  Artificial intervertebral disc replacement  Clinical outcomes

中文摘要:

  【摘要】 目的：评定腰椎人工椎间盘置换术（TDR）治疗腰椎间盘退变性疾病的中长期疗效。方法： 1999年12月~2006年12月应用Charite SB Ⅲ假体进行腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病患者65例，其中随访时间≥5年的患者48例，共52个假体。均在术前和末次随访时进行疼痛VAS评分和Oswestry功能障碍指数（ODI）评定，测量术前及末次随访时手术节段的活动度和椎间隙高度。对上述数据进行统计学分析。结果: 随访时间≥5年但＜10年患者（A组）33例，≥10年者（B组）15例。术前、末次随访时疼痛VAS评分，A组分别为94.0±6.3分、23.0±3.1分，B组分别为92.0±5.8分、21.0±2.2分，每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时ODI，A组分别为（66.0±4.2）%、（12.0±2.9）%，B组分别为（65.0±7.8）%、（9.0±2.8）%，每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时手术节段活动度，A组分别为5.0°±2.3°、6.0°±1.1°，B组分别为4.0°±3.8°、6.0°±2.2°，每组末次随访时与术前比较均无统计学差异（P＞0.05）；末次随访时3例患者手术节段基本丧失活动度（平均为1.2°±0.4°，术后5年1例，术后7年2例），其余患者保留了2°~10°的活动度，平均为6.5°。48例患者中，出现相邻节段退变4例，其中1例患者术后8年出现腰痛，影像学检查发现手术相邻上位节段椎间盘退变并膨出，行手术治疗；1例患者术后7年手术相邻上位节段椎间隙高度较术前降低＞2mm，2例（术后5年、8年各1例）患者手术相邻上位节段椎体前缘骨赘高度＞3mm。2例出现假体移位（分别于术后5年和6.5年），3例出现异位骨化（分别于术后6年、7年和9年），均未出现临床症状。结论：腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效较为满意。

英文摘要:

  【Abstract】 Objectives: To determine the mid- and long-term clinical results of lumbar total disc replacement(TDR) in patients with degenerative disc diseases. Methods: From December 1999 to December 2006, 78 patients with lumbar intervertebral disc degenerative diseases were treated with TDR. Among these patients, 48 patients(52 prosthesis) had follow-ups of no less than 5 years. Clinical and radiographic results of these patients were evaluated before surgery and at final follow-up. The clinical outcomes were evaluated by Visual Analogue Scale(VAS) and Oswestry disability index(ODI). Radiographic parameters including range of motion(ROM) and intervertebral disc height(IDH) of the index level were evaluated by A-P and dynamic X-ray. Results: 33 patients had 5 to 10 years′（including 5 years′, not including 10 years′） follow-up(group A), and 15 patients had more than 10 years′(including 10 years′) follow-up(group B). VAS score: group A had 94.0±6.3 preoperatively and 23.0±3.1 at final follow-up; group B had 92.0±5.8 preoperatively and 21.0±2.2 at final follow-up, which showed significant difference between preoperative score and final follow-up score in each group(P＜0.05). ODI: ODI of group A was (66.0±4.2)% preoperatively and (12.0±2.9)% at final follow-up; It was (65.0±7.8)% group B preoperatively and (9.0±2.8)% at final follow-up. The difference of ODI between preoperation and final follow-up in each group was significant(P＜0.05). ROM: group A had a ROM of 5.0°±2.3° preoperatively and 6.0°±1.1° at final follow-up; group B had a ROM of 4.0°±3.8° preoperatively and 6.0°±2.2° at final follow-up. There was no significant difference between preoperative ROM and the final follow-up ROM（P＞0.05）. 3 cases lost ROM at the index level(average 1.2°±0.4°, one occurred at 5 years after TDR and the other two at 7 years after TDR), while others remained an average ROM of 6.5°(range, 2°-10°). 4 cases developed adjacent-level degeneration, but only one was symptomatic at upper disc and needed reoperation(8 years after TDR). One of the 4 cases lost disc height over 2mm at final follow-up(7 years after TDR), and the other 2 cases had ossification in the anterior part of the upper vertebral body over 3mm(one at 5 years, the other at 8 years). 2 prosthesis were found to be displaced(one at 5 years, the other at 6.5 years) and 3 cases developed heterotopic ossification(respectively at 6, 7 and 9 years), but none of them had symptoms. Conclusions: The mid- and long-term outcome of lumbar TDR for intervertebral disc degenerative diseases with SB Charite Ⅲ prosthesis is of satisfactory.