不同融合节段后路减压椎间融合内固定术对邻近节段稳定性影响的影像学分析

Radiologic stability analysis of adjacent segments after different fusion segments of posterior lumbar interbody fusion

目的探讨单节段、双节段和三节段后路椎间融合器置入椎弓根内固定术(posterior lumbar interbody fusion,PLIF)对融合节段邻近节段稳定性的影响。方法回顾性单节段(A组),双节段(B组)和三节段(C组)PLIF,共45例,对融合节段邻近节段稳定性的影响,每组纳入15例,测量术前、术后腰椎前凸角度及上位邻近节段术前、术后活动度。结果 A组患者末次随访与术前比较,腰椎活动度平均减少10.4°,邻近节段活动度平均增加2.1°;B组患者末次随访与术前比较,腰椎活动度减少11.4°,邻近节段活动度平均增加1.9°;C组患者末次随访与术前比较,腰椎活动度减少16°,邻近节段活动度平均增加8.1°。融合邻近节段活动度,A组:术前(3.6±2.0)°,术后(6.5±1.6)°;B组:术前(8.4±5.5)°,术后(9.8±9.5)°;C组:术前(5.0±4.5)°,术后(13.0±7.6)°,差异均有统计学意义(P<0.01)。3组术后邻近节段活动度组间比较,差异有统计学意义(P<0.01)。结论随着融合节段增加,邻近节段活动度也随之增加。根据术前腰椎前凸角度,术中适度恢复腰椎生理前凸角度,是维持邻近节段稳定性的有效方法。

Objective To investigate the radiologic stability of adjacent segments after single, double and triple fusion segments of posterior lumbar interbody fusion （ PLIF ）. Methods All 45 patients who were treated by PLIF were divided into 3 groups, including group A of single segment, group B of double segments and group C of triple segments, with 15 patients in each group. The effects on the stability of adjacent segments after fusion were retrospectively analyzed. The preoperative and postoperative lumbar lordosis angle and range of motion （ ROM ） of upper adjacent segments were measured. Results The results showed the lumbar ROM was decreased in the latest follow-up when compared with that preoperatively by 10.4° in group A, 11.4° in group B and 16° in group C on average. And the ROM of adjacent segments was increased in the latest follow-up when compared that preoperatively by 2.1° in group A, 1.9° in group B and 8.1° in group C on average. The preoperative ROM of adjacent segments was （ 3.6±2.0 ）°, （ 8.4±5.5 ） ° and （ 5.0±4.5 ）° in group A, group B and group C, and the postoperative ROM was （ 6.5±1.6 ） °, （ 9.8±9.5 ）° and （ 13.0±7.6 ） o respectively. The differences between the preoperative and postoperative ROM in each group were statistically significant （ P〈0.01 ）, and the differences of the postoperative ROM among all groups were statistically significant （ P〈0.01 ）. Conclusions With the adding of fusion segments, the ROM of adjacent segments also increases. Based on the preoperative lumbar lordosis angle, a modest recovery of the physiological lordosis angle is achieved during the operation. It is an effective method to maintain the stability of adjacent segments.