腰椎Activ L人工椎间盘置换术后影像学表现与临床疗效的相关性分析

Radiological changes after Activ L total disc replacement and its correlation with clinical outcome

中文关键词:  腰椎人工椎间盘置换术  临床疗效  影像学  相关性分析

英文关键词:Lumar total disc replacement  Outcome  Radiology  Correlation analysis

中文摘要:

  【摘要】 目的：探讨腰椎Activ L人工椎间盘置换术后的影像学表现与临床疗效的相关性。方法：2009年3月~2012年3月，应用Activ L假体对32例腰椎间盘退变性疾患的患者进行人工椎间盘置换术，其中30例患者共36个假体获得12~46个月（平均28.8个月）的随访，随访2年以上者20例（其中随访3年以上15例）。均在术前和末次随访时进行腰、腿痛VAS评分和Oswestry功能障碍指数（ODI）评分，同时测量手术节段和上、下相邻节段的活动度、椎间隙高度及腰椎前凸角。对术前及末次随访时的VAS评分、ODI评分，手术节段和上下相邻节段的活动度、椎间隙高度以及腰椎前凸角分别进行配对t检验，分别以每例患者末次随访时的VAS评分和ODI评分为应变量，以末次随访时的活动度、椎间隙高度以及腰椎前凸角为自变量，进行相关性分析。结果：末次随访时的腰痛VAS评分、腿痛VAS评分和ODI评分与术前比较均有显著改善（P＜0.0001）。末次随访时，手术节段、上位相邻节段活动度明显增加（P＜0.05），而下位相邻节段活动度无明显变化（P＞0.05）；手术节段及其上、下相邻节段椎间隙高度与术前比较均无明显变化（P＞0.05）；腰椎前凸角与术前比较无明显变化（P＞0.05）。末次随访时，手术节段、上下相邻节段的活动度和椎间隙高度及腰椎前凸角与VAS评分和ODI评分均无明显相关性（r＜0.2138，P＞0.05）。结论：腰椎Activ L人工椎间盘置换术治疗腰椎间盘退变性疾患的近中期疗效满意，近中期随访时手术节段、上下位相邻节段的活动度和椎间隙高度与临床疗效无明显相关性。

英文摘要:

  【Abstract】 Objectives: To correlate the radiographic results of patients undergoing Activ L total disc repalcement with clinical outcomes. Methods: From March 2009 to March 2012, 32 patients with degenerative disc disease(DDD) underwent Activ L total disc repalcement, 30 cases(36 prosthesis) of whom received an average follow-up of 28.8 months(range, 12-46 months), 20 of whom with a 2-years follow-up and 15 with a 3-years follow-up. Clinical parameters as visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated preoperatively and at the final follow-up. Radiographic parameters such as range of motion(ROM), intervertebral disc height(IDH) of the index and adjacent segments, and lumbar lordosis were recorded. Preoperative VAS score, ODI score, ROM, IDH and lumbar lordosis were compared with those at postoperation by using paired t test. The correlation between ROM, IDH and lumbar lordosis were reviewed. Results: The VAS(back pain), VAS(leg pain) and ODI score improved significantly at final follow-up(P＜0.0001). At final follow-up, ROM of the index level and the upper adjacent level showed increase significantly(P＜0.05), while the lower adjacent level remained unchange(P＞0.05). IDH of the index level showed no significant increase at the final follow-up(P＞0.05) compared with that before surgery. The IDH of the upper and lower adjacent level showed no significant difference at final follow-up(P＞0.05). Compared with preoperative data, the lumbar lordosis showed no obvious difference at final follow-up(P＞0.05). At final follow-up, the radiographic parameters were not correlated with clinical results(r＜0.2138, P＞0.05). Conclusions: The short and mid-term results of Activ L prosthesis for degenerative disc diseases are satisfying, and radiographic parameters as ROM, IDH and lumbar lordosis are not correlated with clinical results.