人工椎间盘的研究进展和临床应用
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摘要
人工椎间盘置换术是近年来出现的治疗椎间盘退行性变疾病的工具。理论上可以保留置换节段的活动度,减少邻近节段退变的发生,避免出现融合术后的并发症,允许早期功能锻炼。现阶段人工椎间盘理论上的优点仅被在生物力学和运动学测试中被证实,尚缺乏临床检验结果。在组成人工椎间盘的材料上,包括金属,高分子聚合物等。材料要求具有耐体内环境腐蚀性,耐磨损性,组织相容性,抗破坏强度和抗疲劳强度。在固定方式上存在机械固定与骨水泥或骨长入等界面固定。分类方式依据置换的部位可分为颈椎人工椎间盘、腰椎人工椎间盘和人工髓核。使用人工椎间盘置换术的近期效果满意,并发症和失败病例均少于融合术。潜在的机械性并发症包括假体下沉和磨损。使用人工椎间盘的早期效果满意,对于保留节段活动度能否减少邻近节段退变仍需长期随访。
Disc arthroplasty is an emerging treatment for patients with disc degeneration. Its theoretical advantages are to maintain motion, decrease the incidence of adjacent segment degeneration, avoid complications related to fusion, and allow early return to function. At this time, the theoretical advantages are unproven clinically but have been confirmed in biomechanical and kinematic investigations. Multicenter studies of both cervical and lumbar prostheses have shown short-term results equivalent to fusion. Neurologic complications and failures have been rare. Prosthetic subsidence and long-term wear will most likely be potential failure mechanisms. Thus far, with the exception of nucleoplasty, these problems have not been observed. The early results are satisfactory, but the basic premise that motion preservation will diminish adjacent segment degeneration is yet unproven. Long-term results are unavailable and failure modes are unknown. Before implantation, the surgeon and patient must understand the experimental nature of the devices.
Disc arthroplasty is an emerging treatment for patients with disc degeneration. Its theoretical advantages are to maintain motion, decrease the incidence of adjacent segment degeneration, avoid complications related to fusion, and allow early return to function. At this time, the theoretical advantages are unproven clinically but have been confirmed in biomechanical and kinematic investigations. Multicenter studies of both cervical and lumbar prostheses have shown short-term results equivalent to fusion. Neurologic complications and failures have been rare. Prosthetic subsidence and long-term wear will most likely be potential failure mechanisms. Thus far, with the exception of nucleoplasty, these problems have not been observed. The early results are satisfactory, but the basic premise that motion preservation will diminish adjacent segment degeneration is yet unproven. Long-term results are unavailable and failure modes are unknown. Before implantation, the surgeon and patient must understand the experimental nature of the devices.
引文
1 Goffin J, Komistek R, Malfouz H, et al. In vivo kinematics of normal, degenerative, fused and disc-replaced cervical spines. Annual Meeting of the American Academy of Orthopaedic Surgeons, New Orleans, LA, 2003
2 Gore DR, Gardner GM, Sepic SB, et al. Roentgenographic findings following anterior cervical fusion. Skeletal Radiol 1986;15:556–9
3 Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease: a report of 50 patients with an average follow-up of 21 years. Spine1998;23:2047–51
4 Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28
5 Goffin J, Geusens E, Vantomme N, et al. Long term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech In press
6 Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 2002;27:2431–4
7 Fuller DA, Kirkpatrick JS, Emery SE, et al. A kinematic study of the cervical spine before and after segmental arthrodesis. Spine 1998;23:1649–56
8 Gurvinder DS, Raghu NN, Andersson GB, et al. Adjacent-level segmental motion after anterior cervical discectomy and fusion: ramifications for fusion versus disc replacement. 31st Annual Meeting of the Cervical Spine Research Society, Phoenix, AR, 2003
9 Puttlitz CM, Rousseau MA, Xu Z, et al. Cervical kinetics are maintained after disc replacement. Thirty First Annual Meeting of the Cervical Spine Research Society, Phoenix AZ, December 2003
10 DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 2003;16:314–23
11 Brodsky AE, Hendricks RL, Khalil MA, et al. Segmental (‘floating’) lumbar spine fusions. Spine 1989;14:447–50
12 Abe E, Nickel T, Buttermann GR, et al. Lumbar intradiscal pressure after posterolateral fusion and pedicle screw fixation. Tohoku J Exp Med 1998;186:243–53
13 Cauchoix J, David T. Lumbar arthrodesis: results after more than 10 years. Rev Chir Orthop Reparatrice Appar Mot 1985;71:263–8
14 Hambly MF, Wiltse LL, Raghavan N, et al. The transition zone above a lumbosacral fusion. Spine 1998;23:1785–92
15 Kumar MN, Jacquot F, Hall H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative discdisease. Eur Spine J 2001;10:309–313
16 Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 1988;13:375–7
17 Fritzell P, Hagg O, Nordwall A, et al. Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J 2003;12:178–89
18 Deyo RA, Nachemson A, Mirza S. Spinal-fusion surgery: the case for restraint. N Engl J Med 2004;350:722–6
19 Weinhoffer SL, Guyer RD, Herbert M, et al. Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine 1995;20:526–31
20 Axelsson P, Johnsson R, Stromqvist B. The spondylolytic vertebra and its adjacent segment: mobility measured before and after posterolateral fusion. Spine 1997;22:414–7
21 Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine 1997;22:2622–4
22 Wang JC, McDonough PW, Kanim LE, et al. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 2001;26:643–6
23 Kasai Y, Iida R, Uchida A. Metal concentrations in the serum and hair of patients with titanium alloy spinal implants. Spine 2003;28:1320–6
24 Silber JS, Anderson DG, Daffner SD, et al. Donor sitemorbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134–9
25 Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery 2002;51:840–5
26 Anderson PA, Rouleau JP, Bryan VE, et al. Wear analysis of the Bryan Cervical Disc Prosthesis. Spine 2003;28(suppl):186–194
27 Hallab N, Link HD, McAfee PC. Biomaterial optimization in total disc arthroplasty. Spine 2003;28(suppl):139 –52
28 Goffin J, Van Calenbergh F, van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 2003;28:2673–8
29 Zigler JE, Burd TA, Vialle EN, et al. Lumbar spine arthroplasty. Early results using the ProDisc II: a prospective randomized trial of arthroplasty versus fusion. Spine 2003;28(suppl):352– 61
30 Bennett SE, Schenk RJ, Simmons ED. Active range of motion utilized in the cervical spine to perform daily functional tasks. J Spinal Disord Tech 2002; 15:307–311
31 Dvorak J, Antinnes JA, Panjabi M, et al. Age and gender related normal motion of the cervical spine. Spine 1992;17(suppl):S393–S398
32 Dvorak J, Vajda EG, Grob D, et al. Normal motion of thelumbar spine as related to age and gender. Eur Spine J 1995;4:18–23
33 Dooris AP, Goel VK, Grosland NM, et al. Load-sharing between anterior and posterior elements in a lumbar motion segment implanted with an artificial disc. Spine 2001;26:E122–E129
34 Brittberg M, Peterson L, Sjogren-Jansson E, et al. Articular cartilage engineering with autologous chondrocyte transplantation: a review of recent developments. J Bone Joint Surg Am 2003;85:109–15
35 O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am 1998;80:1795–812
36 Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review. Eur Spine J 2002;11(suppl):65– 84
37 Edeland HG. Suggestions for a total elasto-dynamic intervertebral disc prosthesis. Biomater Med Devices Artif Organs 1981;9:65–72
38 Ray CD. The PDN prosthetic disc-nucleus device. Eur Spine J 2002; 11(suppl):137–142
39 Bao QB, Yuan HA. New technologies in spine: nucleus replacement. Spine 2002;27:1245–7
40 Sagi HC, Bao QB, Yuan HA. Nuclear replacement strategies. Orthop Clin North Am 2003;34:263–7
41 Cunningham BW, Lowery GL, Serhan HA, et al. Total disc replacement arthroplasty using the AcroFlex lumbar disc: a non-human primate model. Eur Spine J 2002;11(suppl):115–23
42 Delamarter RB, Fribourg DM, Kanim LFA, et al. ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 2003;28(suppl):167–75
43 Hochschuler SH, Ohnmeiss DD, Guyer RD, et al. Artificial disc: preliminary results of a prospective study in the United States. Eur Spine J 2002; 11(suppl):106 –10
44 Wigfield CC, Gill SS, Nelson RJ, et al. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 2002;27:2446–52
45 Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. Spine 2003;28(suppl):307–13
46 Jin DD, Qu DB, Zhao L, et al. Prosthetic disc nucleus (PDN) replacement for lumbar disc herniation: preliminary report with six months’ follow-up. J Spinal Disord Tech 2003;16:331–7
47 Shim CS, Lee SH, Park CW, et al. Partial disc replacement with the PDN prosthetic disc nucleus device: early clinical results. J Spinal Disord Tech 2003;16:324–30
48 Bertagnoli R, Schonmayr R. Surgical and clinical results with the PDN prosthetic disc-nucleus device. Eur Spine J 2002;11(suppl):8
49 Lemaire JP, Skalli W, Lavaste F, et al. Intervertebral disc prosthesis: results and prospects for the year 2000. Clin Orthop 1997;337:64–76
50 Blumenthal SL, Ohnmeiss DD, Guyer RD, et al. Prospective study evaluating total disc replacement: preliminary results. J Spinal Disord Tech 2003;16: 450–4
51 Tropiano P, Huang RC, Girardi FP, et al. Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year. J Spinal Disord Tech 2003;16:362–8
52 LeHuec JC, Aunoble S, Friesem T, et al. Maverick total lumbar disk prosthesis: biomechanics and early clinical results. Eur Spine J. In press
53 Heller J, Goffin J. Classification of paravertebral ossification after insertion of the Bryan Cervical Disc Prsothesis. 31st Annual Meeting of the Cervical Spine Research Society, Phoenix, AR, 2003
54 McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacementporous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003; 28(suppl):176–85
55 van Ooij A, Oner FC, Verbout AJ. Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 2003;16:369–83
56 Gonzalez O, Smith RL, Goodman SB. Effect of size, concentration, surface area, and volume of polymethylmethacrylate particles on human macrophages in vitro. J Biomed Mater Res 1996;30:463–73
57 Goodman SB, Huie P, Song Y, et al. Cellular profile and cytokine production at prosthetic interfaces: study of tissues retrieved from revised hip and knee replacements. J Bone Joint Surg Br 1998;80:531–9
58 Cunningham BW, Orbegoso CM, Dmitriev AE, et al. The effect of spinal instrumentation particulate wear debris: an in vivo rabbit model and applied clinical study of retrieved instrumentation cases. Spine 2003;27:1971–81
59 Lee CK, Langrana NA , Parson JR , et al . The adult spine : Principles and practice. chapter 96. Prosthetic intervertabral disc. Edited by JW Frymoyer , New York : RavenPress , 1991. 2007～2013
2 Gore DR, Gardner GM, Sepic SB, et al. Roentgenographic findings following anterior cervical fusion. Skeletal Radiol 1986;15:556–9
3 Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease: a report of 50 patients with an average follow-up of 21 years. Spine1998;23:2047–51
4 Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28
5 Goffin J, Geusens E, Vantomme N, et al. Long term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech In press
6 Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 2002;27:2431–4
7 Fuller DA, Kirkpatrick JS, Emery SE, et al. A kinematic study of the cervical spine before and after segmental arthrodesis. Spine 1998;23:1649–56
8 Gurvinder DS, Raghu NN, Andersson GB, et al. Adjacent-level segmental motion after anterior cervical discectomy and fusion: ramifications for fusion versus disc replacement. 31st Annual Meeting of the Cervical Spine Research Society, Phoenix, AR, 2003
9 Puttlitz CM, Rousseau MA, Xu Z, et al. Cervical kinetics are maintained after disc replacement. Thirty First Annual Meeting of the Cervical Spine Research Society, Phoenix AZ, December 2003
10 DiAngelo DJ, Roberston JT, Metcalf NH, et al. Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 2003;16:314–23
11 Brodsky AE, Hendricks RL, Khalil MA, et al. Segmental (‘floating’) lumbar spine fusions. Spine 1989;14:447–50
12 Abe E, Nickel T, Buttermann GR, et al. Lumbar intradiscal pressure after posterolateral fusion and pedicle screw fixation. Tohoku J Exp Med 1998;186:243–53
13 Cauchoix J, David T. Lumbar arthrodesis: results after more than 10 years. Rev Chir Orthop Reparatrice Appar Mot 1985;71:263–8
14 Hambly MF, Wiltse LL, Raghavan N, et al. The transition zone above a lumbosacral fusion. Spine 1998;23:1785–92
15 Kumar MN, Jacquot F, Hall H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative discdisease. Eur Spine J 2001;10:309–313
16 Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 1988;13:375–7
17 Fritzell P, Hagg O, Nordwall A, et al. Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J 2003;12:178–89
18 Deyo RA, Nachemson A, Mirza S. Spinal-fusion surgery: the case for restraint. N Engl J Med 2004;350:722–6
19 Weinhoffer SL, Guyer RD, Herbert M, et al. Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine 1995;20:526–31
20 Axelsson P, Johnsson R, Stromqvist B. The spondylolytic vertebra and its adjacent segment: mobility measured before and after posterolateral fusion. Spine 1997;22:414–7
21 Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine 1997;22:2622–4
22 Wang JC, McDonough PW, Kanim LE, et al. Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 2001;26:643–6
23 Kasai Y, Iida R, Uchida A. Metal concentrations in the serum and hair of patients with titanium alloy spinal implants. Spine 2003;28:1320–6
24 Silber JS, Anderson DG, Daffner SD, et al. Donor sitemorbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134–9
25 Goffin J, Casey A, Kehr P, et al. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery 2002;51:840–5
26 Anderson PA, Rouleau JP, Bryan VE, et al. Wear analysis of the Bryan Cervical Disc Prosthesis. Spine 2003;28(suppl):186–194
27 Hallab N, Link HD, McAfee PC. Biomaterial optimization in total disc arthroplasty. Spine 2003;28(suppl):139 –52
28 Goffin J, Van Calenbergh F, van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 2003;28:2673–8
29 Zigler JE, Burd TA, Vialle EN, et al. Lumbar spine arthroplasty. Early results using the ProDisc II: a prospective randomized trial of arthroplasty versus fusion. Spine 2003;28(suppl):352– 61
30 Bennett SE, Schenk RJ, Simmons ED. Active range of motion utilized in the cervical spine to perform daily functional tasks. J Spinal Disord Tech 2002; 15:307–311
31 Dvorak J, Antinnes JA, Panjabi M, et al. Age and gender related normal motion of the cervical spine. Spine 1992;17(suppl):S393–S398
32 Dvorak J, Vajda EG, Grob D, et al. Normal motion of thelumbar spine as related to age and gender. Eur Spine J 1995;4:18–23
33 Dooris AP, Goel VK, Grosland NM, et al. Load-sharing between anterior and posterior elements in a lumbar motion segment implanted with an artificial disc. Spine 2001;26:E122–E129
34 Brittberg M, Peterson L, Sjogren-Jansson E, et al. Articular cartilage engineering with autologous chondrocyte transplantation: a review of recent developments. J Bone Joint Surg Am 2003;85:109–15
35 O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am 1998;80:1795–812
36 Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review. Eur Spine J 2002;11(suppl):65– 84
37 Edeland HG. Suggestions for a total elasto-dynamic intervertebral disc prosthesis. Biomater Med Devices Artif Organs 1981;9:65–72
38 Ray CD. The PDN prosthetic disc-nucleus device. Eur Spine J 2002; 11(suppl):137–142
39 Bao QB, Yuan HA. New technologies in spine: nucleus replacement. Spine 2002;27:1245–7
40 Sagi HC, Bao QB, Yuan HA. Nuclear replacement strategies. Orthop Clin North Am 2003;34:263–7
41 Cunningham BW, Lowery GL, Serhan HA, et al. Total disc replacement arthroplasty using the AcroFlex lumbar disc: a non-human primate model. Eur Spine J 2002;11(suppl):115–23
42 Delamarter RB, Fribourg DM, Kanim LFA, et al. ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 2003;28(suppl):167–75
43 Hochschuler SH, Ohnmeiss DD, Guyer RD, et al. Artificial disc: preliminary results of a prospective study in the United States. Eur Spine J 2002; 11(suppl):106 –10
44 Wigfield CC, Gill SS, Nelson RJ, et al. The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 2002;27:2446–52
45 Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy. Spine 2003;28(suppl):307–13
46 Jin DD, Qu DB, Zhao L, et al. Prosthetic disc nucleus (PDN) replacement for lumbar disc herniation: preliminary report with six months’ follow-up. J Spinal Disord Tech 2003;16:331–7
47 Shim CS, Lee SH, Park CW, et al. Partial disc replacement with the PDN prosthetic disc nucleus device: early clinical results. J Spinal Disord Tech 2003;16:324–30
48 Bertagnoli R, Schonmayr R. Surgical and clinical results with the PDN prosthetic disc-nucleus device. Eur Spine J 2002;11(suppl):8
49 Lemaire JP, Skalli W, Lavaste F, et al. Intervertebral disc prosthesis: results and prospects for the year 2000. Clin Orthop 1997;337:64–76
50 Blumenthal SL, Ohnmeiss DD, Guyer RD, et al. Prospective study evaluating total disc replacement: preliminary results. J Spinal Disord Tech 2003;16: 450–4
51 Tropiano P, Huang RC, Girardi FP, et al. Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year. J Spinal Disord Tech 2003;16:362–8
52 LeHuec JC, Aunoble S, Friesem T, et al. Maverick total lumbar disk prosthesis: biomechanics and early clinical results. Eur Spine J. In press
53 Heller J, Goffin J. Classification of paravertebral ossification after insertion of the Bryan Cervical Disc Prsothesis. 31st Annual Meeting of the Cervical Spine Research Society, Phoenix, AR, 2003
54 McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacementporous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003; 28(suppl):176–85
55 van Ooij A, Oner FC, Verbout AJ. Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 2003;16:369–83
56 Gonzalez O, Smith RL, Goodman SB. Effect of size, concentration, surface area, and volume of polymethylmethacrylate particles on human macrophages in vitro. J Biomed Mater Res 1996;30:463–73
57 Goodman SB, Huie P, Song Y, et al. Cellular profile and cytokine production at prosthetic interfaces: study of tissues retrieved from revised hip and knee replacements. J Bone Joint Surg Br 1998;80:531–9
58 Cunningham BW, Orbegoso CM, Dmitriev AE, et al. The effect of spinal instrumentation particulate wear debris: an in vivo rabbit model and applied clinical study of retrieved instrumentation cases. Spine 2003;27:1971–81
59 Lee CK, Langrana NA , Parson JR , et al . The adult spine : Principles and practice. chapter 96. Prosthetic intervertabral disc. Edited by JW Frymoyer , New York : RavenPress , 1991. 2007～2013
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