颈椎融合术对邻近节段矢状位活动度影响研究

Adjacent segment mobility after anterior cervical discectomy and fusion

目的 探讨颈椎融合术对颈椎邻近节段矢状位活动度的影响.方法 应用回顾性研究的方法,选取北京积水潭医院1999年1月至2006年12月颈前路减压融合手术患者28例,收集患者术前及末次随访影像学资料,评价植骨融合率、融合节段近端、远端节段矢状位活动度、下颈椎整体矢状位活动度.结果 患者术后平均随访（6.3±1.6）年,X线评价融合节段融合率为100%,对融合节段上、下邻近节段矢状位活动度术前与随访相比较,无统计学差异.而下颈椎矢状位总体活动度明显下降,单节段融合术前（46.8±13.4）°,随访时（36.8±9.6）°,差异有统计学意义（t=3.042,P=0.007）,活动度平均减少16.8% 而双节段融合术前48.6°±14.6°,随访时（39.9±7.2）°,差异有统计学意义（t=5.064,P＜0.01）,活动度平均减少35.6%.结论 颈椎融合手术仍是颈椎结构重建的良好方法,短节段融合术并没有增加邻近节段的屈伸活动度,而对下颈椎整体屈伸活动度有一定影响.

Objective To investigate the mobility changes of adjacent segments after fusion retrospectively. Methods A total of 28 patients underwent standard anterior cervical arthrodesis. The kinematic changes occurred at segments adjacent to cervical arthrodesis through a coral bone graft and plating system. The mean follow-up period was 6. 3±1.6 years （3. 6 - 10. 5 ）. Lateral radiographic views of cervical spine in flexion and extension were obtained at pre-operation and follow-up. Rotational motion at adjacent levels was quantified. Results Sagittal range of motion （ ROM ） at adjacent cranial level was 11.2°± 5.0° at pre-operation and 11.4°± 6.4°at follow-up. It was not statistically significant （ P 〉 0. 01 ）.At adjacent caudal level, ROM was 9. 8°±5. 3°, but 10. 2°±4. 6°at follow-up. But it was not statistically significant （ P 〉0. 01 ）. During the follow-up, entire cervical motion （ C2-C7 ） decreased significantly from 46. 8°± 13.4° to 36. 8°± 9. 6° in single-level fusion group, but from 48.6°± 14. 6° to 39. 9°± 7. 2° in double-level fusion group. Conclusion The assumption of an iatrogenically elevated adjacent level mobility by cervical fusion is refuted by the present study.