颈椎前路融合术后相邻节段退变的临床分析

Clinical analysis of adjacent segment degeneration after anterior cervical vertebral fusion

目的探讨颈椎前路融合术后相邻节段退变(ASD)的临床特征。方法回顾性分析80例行颈椎前路融合术治疗的颈椎退行变患者的临床资料。结果本组术后发生ASD 39例(48.8%);单纯头侧ASD 19例(48.7%),单纯尾侧ASD 8例(20.5%),头尾侧ASD 12例(30.8%)。术后发生间隔节段明显退变6例(7.5%),均伴有ASD。单间隙组术后发生ASD 11例(50.0%),3例(13.6%)需二次手术;2个间隙组发生ASD 22例(50.0%),其中6例(13.6%)需要而次手术;3个间隙组发生ASD 6例(42.9%),其中2例(14.3%)需要而次手术。结论颈椎前路融合术促进ASD的发生,应全面掌握颈椎的生物力学特征、术前进行准确评估、术后给予正确的康复指导,以降低ASD的发生率。

Objective To discuss the clinical features of the adjacent segment degeneration （ASD） after anterior cervical vertebral fusion. Methods The clinical data of 80 patients undergoing anterior cervical vertebral fusion were analyzed retrospectively. Results The degeneration rate [7.5% （6/80）] in the interval spinal segments was significantly lower than that [48.7% （39/80）] in ASD after the anterior cervical vertebral fusion （P〈0.05）. Of 39 patients with ASD, 19 （48.7%） had the cephalic ASD, 8 （20.5%） the caudal ASD and 12 （30.8%） the cephalocaudal ASD. Of 22 patients receiving single-level cervical fusion, 11 （50%） suffered from ASD and 11 not. Of 44 patients receiving double-levels cervical fusion, 22 （50.0%） suffered from ASD and 22 not. Of 14 patients receiving triple-levels cervical fusion, 6 （42.9%） suffered from ASD and 8 not. Three patients underwent 2 operations in 22 patients receiving single-level cervical fusion. Six patients underwent 2 operations in 44 patients receiving double-levels cervical fusion. Two patients underwent 2 operations in 14 patients receiving triple-levels cervical fusion. Conclusion Anterior cervical fusion may promote ASD, so we should master the biomechanical characteristics of cervical vertebra, make accurate preoperative assessment, and give postoperative rehabilitation guidance in order to reduce the incidence of ASD.