人工髓核置換和傳統腰椎間盤切除療效分析

[摘要] 目的 探討人工髓核置換和傳統腰椎間盤切除加脊柱融合在治療腰椎間盤突出癥的近期療效。方法 椎間盤突出癥患者20例，分為人工髓核置換(A組)10例和常規手術組(B組)10例。比較兩組手術效果及疼痛功能指數評分和視覺模擬疼痛評分。結果 A、B組優良率分別為90.0%和80.0%(χ2=2.45，P>0.05);A組切口長度、術中出血量、手術時間、術后住院時間、術后椎間隙增加高度較B組有顯著性差異(t=3.57，t=4.82，t=5.87，t=7.04，t=2.78，P均<0.05);兩組治療6月疼痛功能指數評分和視覺模擬疼痛評分明顯低于治療前(t=3.245，t=3.311，t=3.289，t=3.310，P<0.01);組間比較無顯著性差異(P>0.05)。結論 人工髓核置換術治療腰椎間盤突出癥在改善癥狀的同時能夠增加椎間高度，保留腰椎的正常運動功能，為腰椎間盤突出癥的手術治療提供了一種新方法。

[關鍵詞] 腰椎間盤突出癥; 人工髓核; 置換; 生物植入體

[中圖分類號] R681.5 [文獻標識碼] A [文章編號] 1673-9701(2010)05-17-02

Artificial Nucleus Replacement and Conventional Lumbar Intervertebral Disc Resection:An Analysis of Curative Effect

XU Lu

Department of Orthopedics，Longgang Central Hospital，Shenzhen 518116，China

[Abstract] ObjectiveTo investigate the curative effect of prosthetic disc nucleus replacement and traditional lumbar discectomy plus spinal fusion in the treatment of lumbar disc herniation. MethodsTwenty cases of lumbar disc herniation were divided into artificial disc nucleus replacement(Group A，10 cases)and conventional operation group(Group B 10，cases). The operative effect，functional index score and visual analogue pain score in the two group were compared. ResultsThe excellent rates of Groups A and B were 90.0% and 80.0%(t=1.45，P>0.05). There was a significant difference in the index of incision length，blood loss，operative time，postoperative hospital stay and postoperative increase in the intervertebral space between the two groups(t=3.57，t=4.82，t=5.87，t=7.04，t=2.78，P all<0.05). The index of pain functional score and visual analogue pain score in the two groups after treatment were lower than those before treatment(t=3.245，t=3.311，t=3.289，t=3.310，P<0.01)，with no significant difference between the two groups(P>0.05). ConclusionThe prosthetic disc nucleus replacement can improve clinical symptoms，increase disc height and retain the normal lumbar motion，with excellent clinical effectiveness in short-term observation，providing a new method of the surgical treatment of lumbar disc herniation.

[Key words]Lumbar disc herniation; Artificial nucleus; Replacement; Bio-implants

腰椎間盤突出癥是引起腰腿痛的常見病因，單純椎間盤的切除有導致腰椎繼發不穩和疼痛復發的可能，人工髓核置換術可以解除患者的臨床癥狀，恢復椎間高度及生物運動功能[1]。本院應用人工髓核置換術以及常規手術治療腰椎間盤突出癥患者20例，對兩組的近期效果進行比較，現報道如下。

1 臨床資料

1.1 臨床病例

收集2002年6月～2003年12月本院腰椎間盤突出癥20例(男12例，女8例);年齡24～50歲，平均32.1歲。病史3個月～2.5年，平均14.5個月。20例分為椎間盤退變2例，椎間盤膨出2例，椎間盤突出16例。入選病例:無中度以上骨質疏松，不伴嚴重的小關節病變，無椎管狹窄;均經臨床表現并結合CT、MRI檢查而確診;病變部位:L4，5者10例，L5者10例。……