人工腰椎间盘置换的临床应用：现状与未来
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Bai WY, Gu HS, Liao ZH, Liu WQ. Clinical application of artificial lumbar disc replacement: Present and future.Zhongguo Zuzhi Gongcheng Yanjiu. 2013;17(35):6321-6326.
Clinical application of artificial lumbar disc replacement: Present and future
Bai Wen-yuan1, 2, Gu Hong-sheng3, Liao Zhen-hua2, Liu Wei-qiang1, 2 (1Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; 2Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China; 3Shenzhen Second People’s Hospital, Shenzhen 518049, Guangdong Province, China)
白文媛★，女，1989 年生， 黑龙江省宁安市人，汉族， 清华大学在读硕士，主要 从事骨科植入器械的研 究。 83827418@qq.com
通讯作者：刘伟强，教授， 清华大学深圳研究来自百度文库院， 广东省深圳市 518055； 深圳清华大学研究院，广 东省深圳市 518057 weiqliu@hotmail.com
中国组织工程研究 第 17 卷 第 35 期 2013–08–27 出版 Chinese Journal of Tissue Engineering Research August 27, 2013 Vol.17, No.35
www.CRTER.org
doi:10.3969/j.issn.2095-4344.2013.35.016
3 临床应用的意义：总结分析腰椎间盘置换的临床研究现状可为今后腰椎间盘假体的设计以及临床实验 的设计与实施提供指导。 关键词： 骨关节植入物；骨与关节综述；人工假体；人工椎间盘；置换；腰椎；临床实验；部级基金
摘要 背景：人工腰椎间盘置换的基本理念是在稳定病变节段的前提下，力求最小影响相邻节段的生物力学状态， 防止以及减少相邻节段退变的发生率。 目的：分别对人工腰椎间盘置换的适应证和禁忌证、围置换期经济学考量、远期并发症以及人工腰椎间盘置 换与融合术的混合使用效果进行了探讨。 方法：计算机检索 PubMed 数据库、中国期刊全文数据库、中国生物医学文献数据库近十年的相关文献。纳 入腰椎间盘置换术的回顾性和前瞻性临床实验报告，排除观点重复的文章，最后对 34 篇文献进行归纳与分析。 结果与结论：1982 年人工腰椎间盘假体首次临床应用以来，已有许多关于腰椎间盘置换的临床报道，然而对 临床实验中遇到的许多问题始终没有统一答案。人工腰椎间盘置换的适应证和禁忌证应考虑到置换节段数对 临床结果的影响、小关节退变对临床结果的影响、既往有腰椎间盘手术史患者的选择、患者年龄、椎间盘置 换前休息时间等因素。评价腰椎间盘置换是否优于传统的腰椎融合，可以从椎间盘置换中出血量、手术时间、 置换后住院时间等方面进行考量。腰椎间盘置换后较常见的并发症有异位骨化、植入物机械故障、相邻节段 和小关节退变。将人工腰椎间盘置换与融合术的混合使用治疗多节段腰椎间盘病变，使两种手术干预方法互 补不足，得到优于单独使用的手术疗效。
Abstract BACKGROUND: The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE: To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as well as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS: The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION: Since the first artificial lumbar disc prosthesis designed to be commercially distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The
Supported by: National Science and Technology Planning Project, No.2012BAI18B05*; Shenzhen Key Laboratory Upgrading Project, No. ZDSY20120616140540279*
文章亮点： 1 此问题的已知信息：人工腰椎间盘假体的开发需经过有限元分析、体外标本力学实验、摩擦磨损实验、
动物实验等体外辅助评估手段来完善并确定其合理性和安全性。 2 文章增加的新信息：讨论了人工腰椎间盘置换术的有效性和安全性、手术的适应证与禁忌证、围手术
期经济学、远期并发症、椎间盘置换与脊柱融合混合手术等方面的研究进展，并对腰椎人工椎间盘置换临床 实验的发展进行了展望。
中图分类号:R318 文献标识码:A 文章编号:2095-4344 (2013)35-06321-06
收稿日期：2013-04-12 修回日期：2013-05-29 (201304131/W·C)
Bai Wen-yuan★, Studying for master’s degree, Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China 83827418@qq.com
[http://www.crter.org]
白文媛，顾洪生，廖振华，刘伟强. 人工腰椎间盘置换的临床应用：现状与未来[J].中国组织工程研究，2013，17(35):6321-6326.
人工腰椎间盘置换的临床应用：现状与未来**★
白文媛 1，2，顾洪生 3，廖振华 2，刘伟强 1，2 (1 清华大学深圳研究生院，广东省深圳市 518055；2 深圳清华大学研究院，广东省深圳 市 518057；3 深圳市第二人民医院，广东省深圳市 518049)
Corresponding author: Liu Wei-qiang, Professor, Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China weiqliu@hotmail.com
Received: 2013-04-12 Accepted: 2013-05-29
ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH
6321
白文媛，等. 人工腰椎间盘置换的临床应用：现状与未来
www.CRTER.org
intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone. Key Words: bone and joint implants; review of bone and joint implants; artificial prosthesis; artificial disc; arthroplasty; lumbar spine; clinical trials; provincial grants-supported paper
Clinical application of artificial lumbar disc replacement: Present and future
Bai Wen-yuan1, 2, Gu Hong-sheng3, Liao Zhen-hua2, Liu Wei-qiang1, 2 (1Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; 2Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China; 3Shenzhen Second People’s Hospital, Shenzhen 518049, Guangdong Province, China)
白文媛★，女，1989 年生， 黑龙江省宁安市人，汉族， 清华大学在读硕士，主要 从事骨科植入器械的研 究。 83827418@qq.com
通讯作者：刘伟强，教授， 清华大学深圳研究来自百度文库院， 广东省深圳市 518055； 深圳清华大学研究院，广 东省深圳市 518057 weiqliu@hotmail.com
中国组织工程研究 第 17 卷 第 35 期 2013–08–27 出版 Chinese Journal of Tissue Engineering Research August 27, 2013 Vol.17, No.35
www.CRTER.org
doi:10.3969/j.issn.2095-4344.2013.35.016
3 临床应用的意义：总结分析腰椎间盘置换的临床研究现状可为今后腰椎间盘假体的设计以及临床实验 的设计与实施提供指导。 关键词： 骨关节植入物；骨与关节综述；人工假体；人工椎间盘；置换；腰椎；临床实验；部级基金
摘要 背景：人工腰椎间盘置换的基本理念是在稳定病变节段的前提下，力求最小影响相邻节段的生物力学状态， 防止以及减少相邻节段退变的发生率。 目的：分别对人工腰椎间盘置换的适应证和禁忌证、围置换期经济学考量、远期并发症以及人工腰椎间盘置 换与融合术的混合使用效果进行了探讨。 方法：计算机检索 PubMed 数据库、中国期刊全文数据库、中国生物医学文献数据库近十年的相关文献。纳 入腰椎间盘置换术的回顾性和前瞻性临床实验报告，排除观点重复的文章，最后对 34 篇文献进行归纳与分析。 结果与结论：1982 年人工腰椎间盘假体首次临床应用以来，已有许多关于腰椎间盘置换的临床报道，然而对 临床实验中遇到的许多问题始终没有统一答案。人工腰椎间盘置换的适应证和禁忌证应考虑到置换节段数对 临床结果的影响、小关节退变对临床结果的影响、既往有腰椎间盘手术史患者的选择、患者年龄、椎间盘置 换前休息时间等因素。评价腰椎间盘置换是否优于传统的腰椎融合，可以从椎间盘置换中出血量、手术时间、 置换后住院时间等方面进行考量。腰椎间盘置换后较常见的并发症有异位骨化、植入物机械故障、相邻节段 和小关节退变。将人工腰椎间盘置换与融合术的混合使用治疗多节段腰椎间盘病变，使两种手术干预方法互 补不足，得到优于单独使用的手术疗效。
Abstract BACKGROUND: The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE: To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as well as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS: The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION: Since the first artificial lumbar disc prosthesis designed to be commercially distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The
Supported by: National Science and Technology Planning Project, No.2012BAI18B05*; Shenzhen Key Laboratory Upgrading Project, No. ZDSY20120616140540279*
文章亮点： 1 此问题的已知信息：人工腰椎间盘假体的开发需经过有限元分析、体外标本力学实验、摩擦磨损实验、
动物实验等体外辅助评估手段来完善并确定其合理性和安全性。 2 文章增加的新信息：讨论了人工腰椎间盘置换术的有效性和安全性、手术的适应证与禁忌证、围手术
期经济学、远期并发症、椎间盘置换与脊柱融合混合手术等方面的研究进展，并对腰椎人工椎间盘置换临床 实验的发展进行了展望。
中图分类号:R318 文献标识码:A 文章编号:2095-4344 (2013)35-06321-06
收稿日期：2013-04-12 修回日期：2013-05-29 (201304131/W·C)
Bai Wen-yuan★, Studying for master’s degree, Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China 83827418@qq.com
[http://www.crter.org]
白文媛，顾洪生，廖振华，刘伟强. 人工腰椎间盘置换的临床应用：现状与未来[J].中国组织工程研究，2013，17(35):6321-6326.
人工腰椎间盘置换的临床应用：现状与未来**★
白文媛 1，2，顾洪生 3，廖振华 2，刘伟强 1，2 (1 清华大学深圳研究生院，广东省深圳市 518055；2 深圳清华大学研究院，广东省深圳 市 518057；3 深圳市第二人民医院，广东省深圳市 518049)
Corresponding author: Liu Wei-qiang, Professor, Graduate School of Shenzhen, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China weiqliu@hotmail.com
Received: 2013-04-12 Accepted: 2013-05-29
ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH
6321
白文媛，等. 人工腰椎间盘置换的临床应用：现状与未来
www.CRTER.org
intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone. Key Words: bone and joint implants; review of bone and joint implants; artificial prosthesis; artificial disc; arthroplasty; lumbar spine; clinical trials; provincial grants-supported paper