双节段人工腰椎间盘置换术的疗效与探讨_临床医学论文.docVIP

双节段人工腰椎间盘置换术的疗效与探讨_临床医学论文 双节段人工腰椎间盘置换术的疗效与探讨_临床医学论文 作者：廖翔，高志增，黄山虎，杨述华【摘要】 ［目的］观察采用以双段SB Charité Ⅲ人工椎间盘置换术治疗退变性腰椎间盘疾病的临床结果并探讨其可行性。［方法］自2000年10月至2006年8月，对22例L4～S1退变的病例采用双节段人工腰椎间盘置换术，男16例，女6例；年龄43～54岁，平均48岁；均获得随访，随访时间10～61个月（平均37.4个月），分别于手术前后对患者的情况进行JOA评分和影像学对比。［结果］术后病例JOA评分较术前显著提高（P＜0.05）。按FRANKLE标准，JOA评分改善率1年后优12例，良7例，可3例；3年后共获得随访18例，其中优10例，良5例，可3例。术后X线片显示人工椎间盘位置正确，椎间隙高度恢复正常，椎间活动度得到维持。15例患者返回原工作，2例变换工作，1例退休。所有病例无假体功能并发症发生，无假体松动、半脱位、下沉。［结论］在严格适应证的前提下，双节段人工椎间盘置换术是可以获得满意临床疗效的，可在有条件的医院积极开展。 【关键词】 人工椎间盘； 置换； 假体； 腰椎退变 Abstract：［Objective］To investigate the clinical results of two［Method］From October 2000 to August 2006,22 patients who suffered degenerative disc disease from L4 to S1 underwent two level artificial lumbar disc replacement with SB Charité Ⅲ prosthesis.There were 16 men and 6 women.The average age of the patient at surgery was 48 years（range,43 to 54 years）.The duration of followwith an average of 59.5 months.JOA score and radiological outcomes were used to access the curative effect.［Result］The average postoperative JOA score was statistically significantly higher than preoperative JOA score（P＜0.05）.According to the FRANKLE evaluation,12 patients had excellent improvement rate of JOA,7 had good improvement and 3 had suboptimal improvement in I year follow up;10 patients had excellent impmwment,5 had good improvement and 3 had suboptimal improvement in 3 year follow up.Plain Xray films confirmed that the disc prosthesis was placed in accurate position and the intervertebral height and lumbar spine motion were restored.No subluxatioo and loosen of the prosthesis were identified.Complication related to the devices had not occurred.［Conclusion］Two be developed in conditional hospitals. Key words：spinal tuberculosis; spinal supress; debridement; bone graft; internal fixation 人工椎间盘置换术（total disc replacement，TDR）是现代脊柱外科治疗退行性腰椎间盘疾病（degenerative disc disease，DDD）的发展方向之一，它不仅着眼于消除已有病症，还考虑到了如何避免将来可能出现的疾患。因各种病因导致的DDD行腰椎间盘切除或前路腰椎融合术治疗后，尽管可使大部分腰背痛患者获得满意疗效，但其不足也是明显的：增加了