摘要
目的介绍人工髓核置换术治疗腰椎间盘突出症的手术方法并评价其近期临床疗效。方法自2002年3～4月采用人工髓核置换术治疗腰椎间盘突出症患者9例,男6例,女3例;年龄22～48岁,平均33.4岁;病史8个月～3.6年,平均18.4个月。均为单间隙病变,以单纯腰痛为主者2例,腰痛伴一侧下肢放射痛或双侧下肢放射痛以一侧为主者7例。手术节段为L4,56例,L5S13例;后侧入路8例,经腹膜后侧前方入路1例。随访12～13个月,平均12.3个月。根据症状改善情况和影像学资料评价手术效果。结果手术时间45～120min,平均60min;术中出血50～150ml,平均120ml。术后4～5d戴腰围下地活动,术后6周去腰围恢复正常活动。根据Oswestry下腰痛和功能不利评分,临床成功率88.9%。复查X线片示术后和术前椎间隙高度百分比为128%。1例患者术后腰痛缓解不明显,第4d出现健侧下肢放射痛,经卧床、脱水治疗后缓解。2例随访时摄正侧位X线片示植入物轻度移位,未见腰椎生理弧度异常改变,腰椎活动度正常。未见植入髓核脱出、感染等并发症。结论人工髓核置换术在改善症状的同时能够增加椎间高度,维持腰椎的正常运动功能,近期临床疗效满意。
Objective To introduce the operative procedure of prosthetic disc nucleus(PDN)re-placement and investigate its clinical effectiveness in the treatment of lumbar disc herniation.Methods Nine cases of lumbar disc herniation were treated with PDN replacement from March2002to April2002.There were6males and3females,the average age of the patients was33.4years ranging from22to48years.The interval between the onset of the symptoms and the diagnosis was averagely18.4months,ranging from8months to3.6years.All of the patients were evaluated by anteroposterior and lateral radiography,computer-ized tomography and,if necessary,magnetic resonance imaging.The low back pain was predomi nant in two patients,the low back pain associated with radicular leg pain in6patients.The height of disc space became narrowed in varying grade.The operated level was at L 4-5 in6patients,L 5 S 1 in3patients.The standard pos-terior approach was used in8patients;the anterior lateral retroperitoneal approach was adopted in1patient.8cases were implanted with a single PDN,and1case with a couple of PDNs.Results All patients were followed up12to13months(average12.3months).The estimated intraoperative blood loss ranged from50to150ml (mean120ml ),and the total operation time ranged from45to120min(mean60min).The patients wore a brace for the first6weeks.Based on Oswestry low back pain and dis ability scores,the clinical successful rate was88.9%.The average percentage of the postoperative to preoperative disc height was128%.The slight displacement of PDN was observed in2patients,however there was no change of lumbar spinal mo bility.1patient had a bad recovery of back and leg pain.Conclusion PDN re placement can improve clinic symptoms,increase disc height and restore the normal lumbar motion as well.Its clinical effectiveness is excellent in short-term observation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第6期353-357,共5页
Chinese Journal of Orthopaedics
