脊柱融合内固定术后邻近节段的退行性变

Adjacent-segment degeneration after spine fusion with instrumentation

目的:回顾脊柱融合内固定术后邻近节段的退行性变情况,有助于脊柱内固定术方法的改进。资料来源:应用计算机检索Medline数据库1990-01/2004-12关于脊柱融合内固定术后邻近节段退行性变的文章,检索词:“Adjacent-segmentdegeneration,spinefusionwithinstrumentation”限定文章语言种类为“English”。同时计算机检索中国期刊全文数据库1995-01/2004-12关于脊柱融合内固定术后邻近节段退行性变的文章,检索词:“邻近节段退行性变,脊柱融合内固定术”,限定文章语言种类为中文。资料选择:对资料进行初审,选取包括脊柱融合内固定术后邻近节段退行性变的文献,然后筛除非随机实验的研究,对剩余的文献开始查找全文,以是随机对照实验作为纳入标准,排除重复性研究文献。资料提炼:共收集97篇关于脊柱内固定术后邻近节段退行性变的随机和非随机实验,38个实验符合纳入标准,排除59篇。36个实验包括运用不同方法及在脊柱不同节段进行内固定融合术,并且对术后邻近节段退行性变情况进行了分析。资料综合:脊柱融合内固定术后不同活动方式及不同融合部位对邻近节段退行性变的生物力学产生不同影响,邻近节段退行性变的发生率因脊柱融合内固定术后不同时间段,不同部位邻近节段,不同邻近节段而发生相应变化。影响邻近节段退行性变的因素包括融合节段数量,融合方法、脊柱内固定方式、年龄及性别因素。结论:脊柱融合术后邻近节段几乎都要发生或多或少的退行性变,而且随着术后时间延长退行性变更加明显,并且与患者融合节段数量、融合方法、脊柱内固定方式、年龄、性别均有密切关系。目前其治疗效果不佳,人工椎间盘置换术是未来治疗邻近节段退行性变的方向之一。

OBJECTIVE： To review the degeneration of adjacent-segment after spine fusion with instrumentation, so as to improve the method of spine fusion with instrumentation. DATA SOURCES： Using the key words of ＂adjacent-segment degeneration, spine fusion with instrumentation＂, a computer search of Medline database was undertaken for articles related to adjacent-segment degeneration after spine fusion with instrumentation published in English between January 1990 and December 2004. Meanwhile, we retrieved the Chinese Journals Full-text database for related Chinese articles between January 1995 and December 2004 with the same key words in Chinese. STUDY SELECTION： All articles were selected firstly, and those related to adjacent-segment degeneration after spine fusion with instrumentation were collected. Articles not randomized researches were excluded. The rest articles of full text were selected on the basis of randomized controlled study and duplicated investigation was excluded. DATA EXTRACTION： Totally 97 articles related to adjacent-segment degeneration after spine fusion with instrumentation with or without randomized trial were selected. Among them, 38 articles were coincident with the inclusive criteria, and 59 ones were excluded. The 36 experiments described the spine fusion with instrumentation with differdnt methods and at different segments, and analysis of adjacent segment degeneration after operation. DATA SYNTHESIS： Biomechanics of adjacent segment degeneration after spine fusion with instrumentation are influenced by different ways of motion and different fusion segments. Rates of adjacent segment degeneration change with time, sites of segment and adjacent segments. Risk factors for adjacent-segment include numbers of fusion segments, methods of fusion, ways of instrumentation, age and sex. CONCLUSION： Degeneration appears in all spine fusion with instrumentation more or less, which turns to be more obvious as time goes on and closely related to the fusion number, fusion way, age, sex, etc. The effect of this treatment is not good now, and the man-made intervertebral disc replacement will be one of the remedial directions in future.