【作者】 李程；

【导师】 聂林；

【作者基本信息】 山东大学 ， 外科学， 2008， 硕士

【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。更多还原

【Abstract】 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.更多还原