腰椎融合术后邻近节段退化的系统回顾分析

A systemic review of adjacent segment deterioration after lumbar fusion

目的探讨腰椎融合术导致融合邻近节段退化(ASDet)发生的概率、发病机制及危险因素。方法通过计算机检索和人工检索,对近30年来国内外发表的关于腰椎融合术导致邻近节段退化的文献进行系统回顾。结果共搜索到301篇相关文献,筛选出30篇符合入选标准的文献。本研究发现ASDet发病率波动在6.3%～100%,邻近节段退变(ASDeg)发病率波动范围8%～100%,邻近节段疾病(ASDis)发病率波动范围6.3%～27.4%。ASDeg平均发病率高于ASDis,P=6.751×10-7(P<0.05)。多种影响因素参与ASDet的发生。结论 ASDet、ASDeg、ASDis发病率差异较大。目前ASDet发生的机制仍不明,绝大多数学者认为与手术引起的邻近节段生物力学机制改变有关。年龄大于60岁、使用内固定器械、损伤上方小关节、改变腰椎前凸和骶倾角、破坏腰椎后方组织结构、已绝经妇女是邻近节段退化性疾病发生的危险因素。然而长节段融合是否导致ASDet的发病率增高还有待进一步研究。

Objective To investigate the incidence, pathogenesis and risk factor of adjacent segment deterioration （ASDet） after lumbar fusion. Methods Our systemic review was based on the literatures of adjacent segment deterioration after lumbar fusion published around the world during the past three decades, through computer retrieval and manual retrieval. Results Out of 301 literatures, a sample of 30 literatures were chosen according to the criteria. The incidence of adjacent segment deterioration （ASDet） ranged from 6.3%-100%, and that of adjacent segment degeneration （ASDeg） ranged from 8%-100%, and that of adjacent segment disease （ASDis） ranged from 6.3%-27.4%. The average incidence of ASDeg was higher than that of ASDis, P =6.751x10-7（P 〈0.05）. The ASDet was related with several factors. Conclusion The incidence of ASDet,ASDeg and ASDis are so different. By now, the pathogenesis of adjacent segment deterioration is still not clear. The majority of experts consider it is related to biomechanical alterations by surgery. Risk factors of ASDet are ages more than 60 years, internal fixators use, injury of facet joint, changes of normal lumbar lordosis and draw of sacrum, tissue and muscle destruction, and menopause. More researches are needed to confirm whether longer fusion leads to higher incidence.