腰椎内固定术后节段影像学改变及内固定取出术对其影响

RADIOGRAPHIC CHANGES OF ADJACENT SEGMENT AFTER LUMBAR INTERNAL FIXATION

目的研究腰椎内固定术后内固定相邻节段在X线片上影像学的改变,以及行内固定取出术后短期椎间隙高度的变化。方法对22例因腰椎管狭窄症行腰椎管减压+内固定术的患者进行22～34个月的随访,测量术前及术后内固定相邻节段的活动度、椎间隙高度、椎体滑脱程度,并进行配对t检验;对其中15例单纯行内固定取出术患者术后进行6～9个月的随访,测量其内固定相邻节段间隙高度,并进行配对t检验。结果腰椎内固定术后,内固定头侧的相邻节段在前屈及后伸活动范围上有增大的趋势,尾侧相邻节段活动度变化不大,内固定术后患者相邻节段的椎间隙高度减低有统计学意义。行腰椎内固定取出术后,患者原内固定相邻节段的高度没有明显变化。结论腰椎内固定术后,相邻节段在影像学上有退变的表现,但其程度与相邻节段退变疾病的发生不平行,行腰椎内固定取出术后,患者相邻节段退变速度有一定的延缓趋势,但确切效果需要长期随访验证。

Objective To investigate the radiographic changes in X-ray views of the segments adjacent to the fusion and the difference of the height of intervertebral space after the removal of the internal fixation in short-term follow-up.Methods Data of 22 patients underwent the post lumbar intervertebral fusion were reviewed and the follow-up period was 22-34 months.The mobility and translations of flexion and extension views,the height of intervertebal space was measured before and after operation separately and compared with paired-T test;15 out of the 22 patients underwent the operation of internal fixation remove after the first stage follow-up.The height of intervetebral space in X-ray was measured after 6-9 months after the second operation and was compared with the height before the internal fixation remove with paired-T test.Results The mobility of cranial segments before and after operation to the fusion was statistically significant while the caudal was not.The difference of the height of intervertebal space before and after the fusion was statistically significant.The height of intertertebal space of the adjacent segment has no significant changed after the remove of instrument.Conclusion There is radiographic evidence of degeneration changes in the adjacent segment after the instrumented lumbar fusion,but it is not related to the incidence of the adjacent segment disease.After the remove of the internal fixation,the adjacent segment is supposed to step down the trend of degeneration,but long-term follow-up is not available.