腰椎融合内固定术融合节段对相邻节段退变影响的临床分析

Clinical Analysis on the Impact of Lumbar Fixation and Intervertebral Fusion to the Adjacent Segment Degeneration

目的：探讨融合节段的长短与相邻节段退变的关系。方法：回顾性分析2002年6月-2008年5月采用后路椎弓根螺钉内固定并椎间植骨融合术治疗的69例腰椎退行性变患者，将其按融合节段数分为A、B、C三组：单节段融合24例为A组；双节段融合26例为B组；多节段融合19例（3个节段及以上）为C组。分别在术前及术后末次随访时测量X线片上固定节段上位相邻节段椎间隙高度、椎体滑移距离、腰椎前凸角、腰骶关节角，并通过影像学评价标准评定相邻节段退变的发生率，分析融合节段数与邻近节段退变的关系。结果：随访时间为18-72个月，平均为31.6个月，所有患者术后均无神经损害加重症状。末次随访时，A组有2例（8.3%）出现上位相邻节段影像学退变，B组为4例（15.4%），C组为4例（21.1%）。A、B两组相邻节段退变发生率比较差异无统计学意义（P〈0.05）；C组相邻节段退变发生率与其他两组比较差异有统计学意义（P〈0.05）。结论：腰椎后路融合内固定术会增加相邻节段退变，融合固定节段越多，相邻节段退变发生率越高。

Objective：To investigate the relationship between postoperative degeneration of adjacent segment and fusion segment number of lumbar vertebra.Method：A retrospective analysis of 69 patients were made,who underwent pedicle screws fixation and posterior lumbar intervertebral fusion for lumbar degenerative disease form June 2002 to May 2008. According to the number of lumbar fusion segments,those patients were divided into three groups. The group A was single segment fusion（24 cases）;the group B was double segments fusion（26 cases）and the group C was multi-segments fusion（ ≥ 3 segments,19 cases）. The intervertebral height,displacement of slippage of the adjacent segment,lumbar lordosis angle and lumbosacral joint angle was measured on the X-ray preoperative and postoperative at the last follow-up. The incidence rate of adjacent segment degeneration was assessed by imaging evaluation criteria,and the relationship between adjacent segment degeneration and the number of fusion segment was analyzed.Result：The average follow-up period was 31.6 months（18-72 months）.All patients had no neurological deterioration. At the last follow-up,there were 2 patients in the group A（8.3%）,4 patients in the group B（15.4%）and 4 patients in group C（21.1%）occurred adjacent segment degeneration. There was no significant difference between group A and group B at the incidence of the adjacent segment degeneration（P＆gt;0.05）. Compared with the group A and B,the group C had significant differences at the incidence of the adjacent segment degeneration（P〈0.05）.Conclusion：The posterior lumbar fixation and intervertebral fusion may increase the adjacent segment degeneration,and the more segment fused the adjacent segment degeneration incidence higher.