人工髓核置换术与单纯髓核摘除术治疗腰椎间盘突出症术后椎间隙高度变化的观察
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摘要
目的评价人工髓核PDN(Prosthetic Disc Nucleus)置换术与单纯髓核摘除术治疗腰椎间盘突出症术后手术节段椎间隙高度变化的观察。
方法2007年2-12月共收治腰椎间盘突出症患者54例。其中采用单纯髓核摘除术治疗48例,PDN置换术6例。均采用后路椎板截骨原位回植术式,其中一例合并峡部裂患者同时行单FSU峡部钩钢板内固定术。术后均进行随访。根据术前术后随访X线侧位片测量病变椎间隙高度,并根据JOA评分标准对术前术后随访时的临床表现进行评分。用SPSS统计软件包对手术前后及两组之间椎间隙高度和JOA评分进行统计分析。
结果单纯髓核摘除组48例,28例患者获得3个月到一年的随访,其中16例有影像学资料。JOA评分术前平均6.21±3.80分,术后平均改善到24.5±2.38分。复查侧位X线片,椎间隙高度较术前平均降低16.1%。人工髓核置换组共6例,6例患者均获得4个月～1年随访,5例复查侧位X线片,或CT、MRI。无一例出现假体脱出或移位。术后X线片显示椎间隙高度较术前平均增加20.2%,JOA评分术前平均5.80±2.31,术后平均改善到25.80±2.21分。对结果进行统计学分析显示(1).单纯髓核摘除组术后较术前椎间隙降低并有统计学意义(t=5.6:p＜0.05)(2).人工髓核置换组术后较术前椎间隙增加并有统计学意义(t=5.7:p＜0.05)(3).两治疗组间椎间盘高度改变程度存在差异(4).两治疗组间JOA评分均较术前明显改善但两组的改善程度无明显统计学差异。
结论(1)人工髓核置换术与单纯髓核摘除术近期临床疗效均满意。(2)单纯髓核摘除术后椎间隙较术前降低而人工髓核置换术后椎间隙高度较术前均有不同程度增加,并得到了保持。(3)对人工髓核两端应用缝线固定在纤维环上,有效的降低了人工髓核的脱出率。
Objective To evaluate height of interver tebral disc of prosthetic disc nucleus(PDN)replacement and discetomy for lumber disc herniation.
Methods Analyse on 54 lumber disc herniation patients whose operation were performed by the authors during Feb.2007 to Dec.2007.48 patients were treated with discetomy and others were treated with PDN(6 cases).28 Patients were examined with roentgenography during follow-up.Lumbarspinal lateral-roentgenographic images of these patients were studied pre-and postoperation and during follow-up. The heights of operated disc spaces were measured.The clinical results were evaluated with JOA Scores system.SPSS 10.0 was used to analyze the date.
Results The average JOA scores at time of preoperation and follow-up were 6.21±3.80 and 24.54±2.38 in discetomy group,5.80±2.31 and 25.80±2.21 in PDN replacement group.The heights of operated disc spaces was 16.1%lower than preopreation in discectomy group,however,it was 20.2%higher than preoperation in PDN replacement group when we follow up by X-Way.
Conclusion(1) Discectomy or PDN replacement may achieve satisfactory short-term results for treatment of lumbar disc herniation.(2) The heights of operated disc spaces was increased comprared with preoperational.(3)Fixing the PDN can reduce the danger of migrations of PDN.
方法2007年2-12月共收治腰椎间盘突出症患者54例。其中采用单纯髓核摘除术治疗48例,PDN置换术6例。均采用后路椎板截骨原位回植术式,其中一例合并峡部裂患者同时行单FSU峡部钩钢板内固定术。术后均进行随访。根据术前术后随访X线侧位片测量病变椎间隙高度,并根据JOA评分标准对术前术后随访时的临床表现进行评分。用SPSS统计软件包对手术前后及两组之间椎间隙高度和JOA评分进行统计分析。
结果单纯髓核摘除组48例,28例患者获得3个月到一年的随访,其中16例有影像学资料。JOA评分术前平均6.21±3.80分,术后平均改善到24.5±2.38分。复查侧位X线片,椎间隙高度较术前平均降低16.1%。人工髓核置换组共6例,6例患者均获得4个月～1年随访,5例复查侧位X线片,或CT、MRI。无一例出现假体脱出或移位。术后X线片显示椎间隙高度较术前平均增加20.2%,JOA评分术前平均5.80±2.31,术后平均改善到25.80±2.21分。对结果进行统计学分析显示(1).单纯髓核摘除组术后较术前椎间隙降低并有统计学意义(t=5.6:p＜0.05)(2).人工髓核置换组术后较术前椎间隙增加并有统计学意义(t=5.7:p＜0.05)(3).两治疗组间椎间盘高度改变程度存在差异(4).两治疗组间JOA评分均较术前明显改善但两组的改善程度无明显统计学差异。
结论(1)人工髓核置换术与单纯髓核摘除术近期临床疗效均满意。(2)单纯髓核摘除术后椎间隙较术前降低而人工髓核置换术后椎间隙高度较术前均有不同程度增加,并得到了保持。(3)对人工髓核两端应用缝线固定在纤维环上,有效的降低了人工髓核的脱出率。
Objective To evaluate height of interver tebral disc of prosthetic disc nucleus(PDN)replacement and discetomy for lumber disc herniation.
Methods Analyse on 54 lumber disc herniation patients whose operation were performed by the authors during Feb.2007 to Dec.2007.48 patients were treated with discetomy and others were treated with PDN(6 cases).28 Patients were examined with roentgenography during follow-up.Lumbarspinal lateral-roentgenographic images of these patients were studied pre-and postoperation and during follow-up. The heights of operated disc spaces were measured.The clinical results were evaluated with JOA Scores system.SPSS 10.0 was used to analyze the date.
Results The average JOA scores at time of preoperation and follow-up were 6.21±3.80 and 24.54±2.38 in discetomy group,5.80±2.31 and 25.80±2.21 in PDN replacement group.The heights of operated disc spaces was 16.1%lower than preopreation in discectomy group,however,it was 20.2%higher than preoperation in PDN replacement group when we follow up by X-Way.
Conclusion(1) Discectomy or PDN replacement may achieve satisfactory short-term results for treatment of lumbar disc herniation.(2) The heights of operated disc spaces was increased comprared with preoperational.(3)Fixing the PDN can reduce the danger of migrations of PDN.
引文
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3. Bertagnoli R, Schonmayr R. Surgical and clinical results with the PDN prosthetic disc-nucleus device. Eur Spine J 2002; 11(Suppl2):143-8
4. Fernsteom U. Arthroplasty with cetercoral endoprothcsis in herniatcd disc and in painful dise. Acta Chir Scand 1966; 357(Hupp1):154-9
5. Bao QB, Higham PA. Hydrogel Intervertebral Dise Nucleus. US Palent: 5192326,9 March 1993
6. Ray CD. The PDN prosthetic disc-nucles device. Eur Spine J2002; 11 (2): 137-42
7. Zigler JE. Lumbar disc replascement: is it time to stop fusion. Dallas: AAOS Proceedings 2002:229-41
8. Klara PM, Ray CD. Artificiul nucleus replacement: clinical experience. Spine 2002;27(12):1374-7
9. Schonmayr R, Sach B, Lotz C. Prosthetic disc nucleus implants: four year patient follow-up. Dallas: Proceedings of AaoS 2002 Annual Mccting 2002:80
10. Zhou SH, McCarthy ID, McGregor AH, et al. Geometricaldismensions of the lower lumbar vertebrae-analysis of data from disitised Ctimages. Eur Spine J 2000 Jun; 9(3):242-8; discussion 249
11. Roberts N, Gratin C, Whitehouse GH. MRI analysis of lumber intervertebral disc height in young and older populations. J Magn Reson Imaging 1997 Sep-Oct;7(5):880-6
12. LeBlanc AD, Evans HJ, Schneider VS, et al. Changges in intervertebral disc cross-sectional area with bed rest and space flight. Spine 1994 Apr 1; 19(7):812-7
13. Frymoyer JW, Newberg A, Pope MH, et al. Spine radiographs inpatients with low-back pain. An epidemiological study in men. J Bone Joint Surg Am 1984 Sep;66(7):1048-55
14. Edmondston SJ, Song S, Bricknell RV, et al. MRI evaluation of lumbar spine flexion and extention in asymptomatic individuals. Man Ther 2000 Aug;5(3):158-64
15. Van Deursen DL, Snijders CJ, van Dieen JH, et al. The effect of passive vertebral rotation on pressure in the nucleus pulposus. J Biomech 2001 Mar; 34(3):405-8
16. Brinckmann P, Horst M. The influence of vertebral body fracture, inteadiscal injuction, and partial discectomy on the radial bulge and height of human lumber discs. Spine 1985; 10(2):138-45
17. Mochida J, Nishimura K, Nomura T, et al. The imporeance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine 1996 Jul 1;21(13):1556-63; discussion 1563-4
18. Qian Z, Tang T, Yang H. The direct repair of the defect and grafting with single segment reduction fixation system in the treatment of lumbar spondylolysis and spondylolisthesis. Ahonghua Wai Ke Za Zhi 1995 Dec; 33(12):711-4
19. Leiwseth G, Salvesen R, Hemminghytt S, et al. Do human lumbar discs reconstitute after chemonucleolysis A 7-year follow-up study. Spine 1999 Feb 15:24(4):342-7; discussion 348
20. Wakano K, Kasman R, Chao EY, et al. Biomechanical analysis of canine intervertebral discs of ter chymopapain injection. A preliminary report. Spine 1983 Jan-Feb; 8(1):59-68
21. Lee SH et al. Copmarison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy. Orthopade 1996 Feb; 25(1):49-55
22. Videman T et al. The long-term effets of rally driving on spinal pathology. Clin Biomech 2000 Feb; 15(2):83-6
23. Keller TS, Nathan M. Height change caused by creep in intervertebral discs: a sagittal plane model. J Spinal Disord 1999 Aug; 12(4):313-24
24. Sambrook PN, Mac Gregor AJ, et al. Genetic influence on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 1999 Feb;42(2):366-72
25. Battie MC, et al. Similarities in degenetative findings on magnetic resonance imagines of the lumbar spines of identicak twins. J Bone Joint Surg Am 1995 Nov;77(11): 1662-70
26. Videman T, Leppavuori J, et al. Intragenic polymorphisms of the vitamin D receptor gene assotiated with intervertebral disc degeneration. Spine 1998 Dec 1;23(23):2477-85
27. Stonecipher T et al. Posterior lumbar interbody fusion with facet-screw fixation.Spine 1989 Apr: 14(4):468-71
28. Murata M, Morio Y, et al. Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain. Arch Orthop Trauma Surg 1994; 113(6):297-301
29. zollner J, Low R, Scancaktaroglu T, et al. Radiological assessment of loss of disk height in acute and chronic degenerative lumbar disk changes. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr2001 Mar; 173(3):187-90
30. Mc Gregor AH, Spinal notion in lumbar degenerative disk disease. J Bone Joint Surg Br 1998 Nov; 80(6):1009-13
31. Karantanas AH et al. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT. Eur Radiol 1998;8(9):1581-5
32. Uoma KL et al. Disc height and signal intensity of the nucleus pulposus on magnetic resonance imaging as indictors of lumbar disc degeneration. Spine 2001 Mar 15;25(6):680-6
33. Berlemann U et al. The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs. Eur Spine J1998:7(3):212-7
34. Berlemann U et al. Ehe role of lumbar lordosis, vertebral end-plate inclination,disc height, and facet orientation in degenerative spondylolisthesis. J Spine Disord 1999 Feb;12(1)68-73
35.Milette PC,Fontaine S,Lepanto L,et al.Differentiating lumbar disc protrusions,disc bulges,and discs with normal contour but abnormal signal intensity.Magnetic resonance imaging with discographic correlations.Spine 1999 Jan 1;24(1):44-53
36.修树勋、李明全、白巍等。腰椎髓核摘除术远期疗效评价。中华骨科杂志,2003,23(9):513-516
37.Holodny AI,Kisza PS,Contractor S,et al.Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc?Quantitative volumetric MRI.Neuroradilogy 2000 Jun;42(6):451-4
38.Chen D,Fay LA,Lok J,et al.Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine.Spine 1995 Jan 1;20(1):74-9
39.Hasegawa T,An HS,Haughton VM,et al.Lumbar foraminal stenosis:critical heights of the intervertebral discs and foramina.A cryomicrotome study in cadavera.J Bone Joint Surg Am 1995 Jan;77(1):32-8
40.马远征、陈兴、薛海滨等。人工髓核置换术治疗腰椎间盘突出症的临床初步报告[J]。2003,23(6):353-357
41.Van Rens TJ,van Horn JR.Long-term results in lumbosacral interbody fusion for spondylolithesis.Acta Orthop Scand 1982 Jun;53(3):383-92
42.金大地、瞿东滨、赵亮等。腰椎间盘人工髓核假体置换术临床应用初步报告[J]。2003,23(5):283-286
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45.Yorimitsu E,Chiba K,Toyama Y,et al.Long-term outcomes of standard discectomy for lumbar disc herniation:a follow-up study of more than 10 years.Spine 2001 Mar 15;26(6)
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62. Mathews HH, Evans MT, Molligan HJ, et al. Laparoscopic discectomy with anterior lumbar interbody fusion. A preliminary review Spine 1995 Aug 15;20(16): 1797-802
63. Pintar FA, Maiman DJ, Hollowell JP, et al. Fusion rate and biomechanical stiffness of hydroxylapatite versus autogenous bone grafts for anterior discectomy.An in vivo animal study. Spine 1994 Nov 15; 19(22):2524-8
2. Loupasis CA, Stanlos K, Kalonis PG Sapkas G, Komcs DS, Hartofilakidis G,Seven to 20-ear outcome of lumbar discectomy. Spine 1999; 24:2313-7
3. Bertagnoli R, Schonmayr R. Surgical and clinical results with the PDN prosthetic disc-nucleus device. Eur Spine J 2002; 11(Suppl2):143-8
4. Fernsteom U. Arthroplasty with cetercoral endoprothcsis in herniatcd disc and in painful dise. Acta Chir Scand 1966; 357(Hupp1):154-9
5. Bao QB, Higham PA. Hydrogel Intervertebral Dise Nucleus. US Palent: 5192326,9 March 1993
6. Ray CD. The PDN prosthetic disc-nucles device. Eur Spine J2002; 11 (2): 137-42
7. Zigler JE. Lumbar disc replascement: is it time to stop fusion. Dallas: AAOS Proceedings 2002:229-41
8. Klara PM, Ray CD. Artificiul nucleus replacement: clinical experience. Spine 2002;27(12):1374-7
9. Schonmayr R, Sach B, Lotz C. Prosthetic disc nucleus implants: four year patient follow-up. Dallas: Proceedings of AaoS 2002 Annual Mccting 2002:80
10. Zhou SH, McCarthy ID, McGregor AH, et al. Geometricaldismensions of the lower lumbar vertebrae-analysis of data from disitised Ctimages. Eur Spine J 2000 Jun; 9(3):242-8; discussion 249
11. Roberts N, Gratin C, Whitehouse GH. MRI analysis of lumber intervertebral disc height in young and older populations. J Magn Reson Imaging 1997 Sep-Oct;7(5):880-6
12. LeBlanc AD, Evans HJ, Schneider VS, et al. Changges in intervertebral disc cross-sectional area with bed rest and space flight. Spine 1994 Apr 1; 19(7):812-7
13. Frymoyer JW, Newberg A, Pope MH, et al. Spine radiographs inpatients with low-back pain. An epidemiological study in men. J Bone Joint Surg Am 1984 Sep;66(7):1048-55
14. Edmondston SJ, Song S, Bricknell RV, et al. MRI evaluation of lumbar spine flexion and extention in asymptomatic individuals. Man Ther 2000 Aug;5(3):158-64
15. Van Deursen DL, Snijders CJ, van Dieen JH, et al. The effect of passive vertebral rotation on pressure in the nucleus pulposus. J Biomech 2001 Mar; 34(3):405-8
16. Brinckmann P, Horst M. The influence of vertebral body fracture, inteadiscal injuction, and partial discectomy on the radial bulge and height of human lumber discs. Spine 1985; 10(2):138-45
17. Mochida J, Nishimura K, Nomura T, et al. The imporeance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine 1996 Jul 1;21(13):1556-63; discussion 1563-4
18. Qian Z, Tang T, Yang H. The direct repair of the defect and grafting with single segment reduction fixation system in the treatment of lumbar spondylolysis and spondylolisthesis. Ahonghua Wai Ke Za Zhi 1995 Dec; 33(12):711-4
19. Leiwseth G, Salvesen R, Hemminghytt S, et al. Do human lumbar discs reconstitute after chemonucleolysis A 7-year follow-up study. Spine 1999 Feb 15:24(4):342-7; discussion 348
20. Wakano K, Kasman R, Chao EY, et al. Biomechanical analysis of canine intervertebral discs of ter chymopapain injection. A preliminary report. Spine 1983 Jan-Feb; 8(1):59-68
21. Lee SH et al. Copmarison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy. Orthopade 1996 Feb; 25(1):49-55
22. Videman T et al. The long-term effets of rally driving on spinal pathology. Clin Biomech 2000 Feb; 15(2):83-6
23. Keller TS, Nathan M. Height change caused by creep in intervertebral discs: a sagittal plane model. J Spinal Disord 1999 Aug; 12(4):313-24
24. Sambrook PN, Mac Gregor AJ, et al. Genetic influence on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 1999 Feb;42(2):366-72
25. Battie MC, et al. Similarities in degenetative findings on magnetic resonance imagines of the lumbar spines of identicak twins. J Bone Joint Surg Am 1995 Nov;77(11): 1662-70
26. Videman T, Leppavuori J, et al. Intragenic polymorphisms of the vitamin D receptor gene assotiated with intervertebral disc degeneration. Spine 1998 Dec 1;23(23):2477-85
27. Stonecipher T et al. Posterior lumbar interbody fusion with facet-screw fixation.Spine 1989 Apr: 14(4):468-71
28. Murata M, Morio Y, et al. Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain. Arch Orthop Trauma Surg 1994; 113(6):297-301
29. zollner J, Low R, Scancaktaroglu T, et al. Radiological assessment of loss of disk height in acute and chronic degenerative lumbar disk changes. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr2001 Mar; 173(3):187-90
30. Mc Gregor AH, Spinal notion in lumbar degenerative disk disease. J Bone Joint Surg Br 1998 Nov; 80(6):1009-13
31. Karantanas AH et al. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT. Eur Radiol 1998;8(9):1581-5
32. Uoma KL et al. Disc height and signal intensity of the nucleus pulposus on magnetic resonance imaging as indictors of lumbar disc degeneration. Spine 2001 Mar 15;25(6):680-6
33. Berlemann U et al. The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs. Eur Spine J1998:7(3):212-7
34. Berlemann U et al. Ehe role of lumbar lordosis, vertebral end-plate inclination,disc height, and facet orientation in degenerative spondylolisthesis. J Spine Disord 1999 Feb;12(1)68-73
35.Milette PC,Fontaine S,Lepanto L,et al.Differentiating lumbar disc protrusions,disc bulges,and discs with normal contour but abnormal signal intensity.Magnetic resonance imaging with discographic correlations.Spine 1999 Jan 1;24(1):44-53
36.修树勋、李明全、白巍等。腰椎髓核摘除术远期疗效评价。中华骨科杂志,2003,23(9):513-516
37.Holodny AI,Kisza PS,Contractor S,et al.Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc?Quantitative volumetric MRI.Neuroradilogy 2000 Jun;42(6):451-4
38.Chen D,Fay LA,Lok J,et al.Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine.Spine 1995 Jan 1;20(1):74-9
39.Hasegawa T,An HS,Haughton VM,et al.Lumbar foraminal stenosis:critical heights of the intervertebral discs and foramina.A cryomicrotome study in cadavera.J Bone Joint Surg Am 1995 Jan;77(1):32-8
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