颈椎前路减压植骨融合术后邻近节段退变情况分析

Analysis of adjacent segment degeneration of patients with anterior cervical discectomy and fusion

目的分析颈椎前路减压植骨融合术后融合椎体邻近节段退变的影响因素。方法选取250例行颈椎前路减压植骨融合内固定手术治疗的患者作为研究对象,观察术后邻近节段退变的发生情况,对退变患者组与无退变患者组各项观察指标进行统计学比较。结果共72例(75个节段)(28.8%)发生术后邻近节段退变,椎间盘退变程度按评分,1分48例,2分21例,3分3例;退变组术前D值(1.26±1.30)mm、术后D值(3.76±3.10)mm,明显小于无退变组的(1.90±1.30)mm与(5.85±3.04)mm(P<0.05);退变组手术后D值比术前增加(2.5±3.21)mm,明显小于无退变组的(3.95±3.13)mm(P<0.05);两组的年龄、性别分布、日本骨科学会评分(JOA评分)、Cobb’s角等无统计学差异(P>0.05)。结论颈椎前路减压植骨融合术后融合椎体邻近节段退变发生率较高;颈椎前凸程度较小、且手术对颈椎前凸程度改善较小是导致邻近节段退变发生的重要影响因素。

Objective To analyze the influencing factors of adjacent segment degeneration of patients with anterior cervical discectomy and fusion.Methods Totally 250 cases of anterior cervical discectomy and fusion were selected for study.The incidence of adjacent segment degeneration was observed and the indexes of degeneration group and non-degeneration group were compared statistically.Results There were 72 cases（75 segment） of adjacent segment degeneration（28.8%）,including 48 cases of degradation score of 1,21 cases of degradation score of 2,3 cases of degradation score of 3.The preoperative D value of degradation group was（1.26±1.30）mm,while（3.76±3.10）mm after operation,indicating significantly lower than that of non-degradation group（P0.05）.The postoperative D value of degradation group increased by（2.5±3.21）mm,notably lower than that of non-degradation group（3.95±3.13）mm（P0.05）.The age,gender distribution,JOA score and Cobb＇s angle of the two groups had no statistical difference（P0.05）.Conclusion The incident rate of adjacent segment degeneration in patients with anterior cervical discectomy and fusion is high.The small degree of cervical lordosis and slight improvement of the degree of cervical lordosis after operation are important influencing factors leading to adjacent segment degeneration.