van Ooij A, Schurink G W H, Oner F C, Verbout A J
Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ Maastricht.
Ned Tijdschr Geneeskd. 2007 Jul 14;151(28):1577-84.
To determine the symptoms in patients who presented with persistent or recurrent backache or leg pain after implantation of an artificial disc prosthesis.
Descriptive.
During the past II years in the Maastricht University Hospital (n=65) and the Utrecht University Medical Centre (n=2), 67 patients were seen with persistent or recurrent backache or leg pain in whom, an average of 53 months previously, one or more SB Charité-III lumbar-disc prostheses had been implanted elsewhere. The results were evaluated.
The most prominent findings were: migration of the prosthesis (n=6); subsidence into the vertebra (n=35); disc degeneration at one or more neighbouring levels (n=34) and arthrosis of facet joints (n=24). In 9 cases, rupture of the metal wire around the polyethylene core was observed and in 5 cases there were radiological signs of polyethylene wear. Re-operation (spondylodesis) was generally unsatisfactory if the prosthesis was left in place. In 21 patients, the prosthesis was removed; all specimens showed polyethylene wear or rupture.
Published results are mostly case series and suffer from observer bias; moreover, the benefits are moderate. Given the uncertain role ofdisc degeneration in patients with chronic backache, the real risk of complications and the uncertain advantages, the implantation ofa disc prosthesis is difficult to defend.
确定人工椎间盘假体植入后出现持续性或复发性背痛或腿痛患者的症状。
描述性研究。
在过去11年中，马斯特里赫特大学医院（n = 65）和乌得勒支大学医学中心（n = 2）共诊治了67例出现持续性或复发性背痛或腿痛的患者，这些患者平均在53个月前于其他地方植入了一个或多个SB Charité-III腰椎间盘假体。对结果进行了评估。
最突出的发现为：假体移位（n = 6）；假体下沉至椎体（n = 35）；一个或多个相邻节段椎间盘退变（n = 34）以及小关节骨关节炎（n = 24）。9例观察到聚乙烯芯周围金属丝断裂，5例有聚乙烯磨损的放射学征象。如果保留假体，再次手术（脊柱融合术）通常效果不佳。21例患者取出了假体；所有标本均显示有聚乙烯磨损或断裂。
已发表的结果大多为病例系列研究，存在观察者偏倚；此外，益处有限。鉴于椎间盘退变在慢性背痛患者中的作用不确定、并发症的实际风险以及益处不明确，椎间盘假体植入难以得到辩护。
