经后路腰椎椎间固定融合术后邻近节段发生椎间盘退行性变的5年随访

Adjacent segment disc degeneration after posterior lumbar fusion fixation:a five-year follow-up

目的:椎间固定融合术改变了腰椎的正常生物力学环境,固定节段上下椎间盘存在应力集中,通过观察经后路腰椎椎间固定融合术后邻近节段椎间盘退行性变的程度,明确是否存在退行性变的发生。方法:1998-08/2002-01解放军第三○九医院骨科收治行腰椎椎间固定融合术后患者40例,所有病例均询问主诉是否有腰痛,进行腰部和神经系统检查、简式McGill疼痛问卷调查、Oswestry功能障碍指数评定,行肌电图椎旁定位明确神经受损情况,X射线检查及MRI检查,观察腰椎固定融合术后邻近节段椎间盘退行性变的发生率和程度。结果:术后随访5年,腰椎固定融合术后邻近节段椎间盘退行性变的发生率为27.5%(11/40),但仅15%患者出现主观不适和阳性体征。结论:腰椎融合术后邻近节段椎间盘发生退行性变的比例较高,应力异常集中是退行性变加速原因,大多数患者在术后5年内并不表现出相应的临床症状和体征,这可能与腰椎管容积较大、椎间盘退行性变程度较小有关。

AIM:Lumbar fusion fixation induces the change of normal biomechanical lumbar environment,and the fixed segments of upper and lower intervertebral discs have the character of stress concentration.This study aimed to observe the degradatio n degree of adjacent lumbar segments after posterior lumbar fusion fixation so a s to confirm whether degradation happens. METHODS:The subjects were 40 patients treated with lumbar fusion fixation in the Department of Orthopaedics,the 309 Hospital of Chinese PLA from August 1998 and January 2002.All the 40 patients were inquired to complain whether having lu mbag.Lumbar and neurological examination,McGill pain questionnaire(MPQ) investig ation,Oswestry disability index(ODI) assessment,paravertebral electromyogram(EMG ) assessment to ascertain nerve injury,X- ray and MRI examination were performe d to observe the degradation incidence and degree of adjacent segments of interv ertebral discs after lumbar fusion fixation. RESULTS:The degradation incidence of adjacent segments of intervertebral disc s after lumbar fusion fixation was 27.5% (11/40),but only 15% patients had su bjective discomfort and positive symptom during 5- year follow- up. CONCLUSION:The degradation of adjacent segments of intervertebral discs after lumbar fusion fixation occurs in a high rate.Stress concentration results in th e acceleration of degradation.Most patients during postoperative 5 years do not have corresponding clinical symptoms and physical signs,which may be related to the big volume of lumbar spinal canal and the low degree of degradation of inter vertebral disc.