脊柱融合术后继发邻近节段退行性变的原因分析及治疗策略

Reason Analysis and Treatment Strategy of Degenerative Changes in Neighboring Segments after Spine Fusion Surgery

目的 探讨脊柱融合术后继发邻近节段退行性变的原因及治疗策略。方法 对2000年12月～2005年12月所做的84例脊柱融合术及再手术患者进行随访，观察术后邻近节段的影像学改变及临床治疗效果，分析出现邻近节段退行性变的原因及治疗对策。结果 84例随访18-78个月，平均（48±7．5）个月。30例出现邻近节段退变（35．7％），26例有影像学改变，其中再手术18例，再手术病例根据Stauffer—Coventry疗效评定：优3例（16．7％），良7例（38．9％），可4例（22．2％），差4例（22．2％）。结论 脊柱融合术后会增加邻近节段退行性疾病的发生；采用恰当的治疗策略可预防和减少邻近节段退行性变的发生。

Objective To discuss the reason and the treatment strategy of degenerative changes in the neighboring section after the spine fusion surgery. Methods Eighty - four patients with spine fusion surgery and the second surgery between December 2000 and December 2005 were followed up. The image changes of neighboring segments and the clinical treatment results were observed. The reason and the treatment strategy of degenerative changes in the neighboring segments were analyzed. Results The 84 patients were followed up for 18 -78 months, average （48 ± 7.5） months. The degenerative changes appearing in the neighboring segments were found in 30 patients （35.7 % ） encounter. The image changes was found in 26 patients and 18 needed a second surgery. The second surgery patients according to Stauffer - Coventry, the curative effect evaluations were done： excellent 3 patients （16.7%）, good 7 （38.9%）, fair 4 （22.2 % ）, and bad 4 patients （22.2 % ）. Conclusion The spine fusion surgery can increase the occurrence of degenerative changes in the neighboring segments. The appropriate treatment strategy can prevent and reduce the occurrence of degenerative changes.