后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响

Effect of the Posterior Ligament Complex on the Adjacent Segment Degeneration after Posterior Lumbar Interbody Fusion

目的探讨后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响。方法 2000年1月至2010年1月在我科实施后路腰椎减压椎间融合内固定治疗L4~5椎间盘突出患者60例。A组（30例）行保留后方韧带复合体的腰椎椎间融合术（posterior lumbar interbody fusion,PLIF）,B组（30例）行切除后方韧带复合体的PLIF术。比较两组手术前、后日本骨科协会（Japanese orthopaedic association,JOA）评分及改善率。术前、末次随访时测量腰椎X线片上L3~4椎间盘的高度和椎间隙动态角度、L3~4椎体滑移距离并进行比较。术前及末次随访时对L3~4椎间盘进行Pfirrmann分级。结果手术前、后两组患者的JOA评分差异有统计学意义（P〈0.05）,术后两组JOA评分差异均无统计学意义（P〉0.05）,两组之间改善率差异无统计学意义（P〉0.05）。A组9例患者出现了L3~4节段的邻近节段退变（adjacent segment disease,ASD）,B组17例出现了L3~4节段的ASD。其中A、B两组均有2例患者为有症状的ASD。术前两组患者X线片上L3~4椎间盘的高度、椎间隙动态角度、L3~4椎体滑移距离相比差异均无统计学意义（P〉0.05）,而末次随访时差异有统计学意义（P〈0.05）。A组末次随访时Pfirrmann分级1级6例,2级22例,3级2例,无4、5级病例。B组末次随访时Pfirrmann分级1级4例,2级24例,3级2例,无4、5级病例。结论腰椎椎间融合术中保留后方韧带复合体可减少术后早期相邻节段退变的发生。

Objective To explore the effect of the posterior ligament complex on the adjacent segment degeneration after posterior lumbar interbody fusion. Methods From January 2000 to January 2010,60 patients were treated by posterior lumbar interbody fusion （PLIF） and internal fixation with posterior lumbar interbody fusion （L4-5 ）. Group A （30 cases） ：the PLIF group （30 cases） underwent PLIF with posterior ligament complex conserved, B group （cases） ：PLIF with posterior ligament complex resected. We compared the JOA score,improve rate before and after surgery of the two groups. At the end of the opera- tion,the height of lumbar 3 - 4 intervertebral disc and the dynamic angle of lumbar intervertebral space were measured and compared with the lumbar 3 - 4 intervertebral disc. Before and at the end of the follow - up, the 3 - 4 lumbar intervertebral disc was graded according to Pfirrmann grade. Results There was significant difference in JOA score before and after operation （P 〈 0.05 ） in both group. There was no significant difference between the two groups （ P 〉 0.05 ）. A group had 9 patients with lumbar 3/4 segment of the ASD, B group had 17 cases of lumbar 3 -4 segment ASD. Among them, each groups had 2 cases of patients with symptoms of ASD. There were not difference in 3 - 4 lumbar intervertebral disc height, intervertebral space dy- namic angle , waist 3 - 4 vertebral slip distance. But at the time of last follow - up significant difference could be found （ P 〈 0.05 ）. At the end of the follow -up A group had 6 cases of Pfirrmann grade 1,22 cases of 2,2 cases of grade 3, no 4,5 cases. B group had 4 cases of Pfirrmann grade 1,24 cases of 2,2 cases of grade 3, no 4,5 cases. Conclusion In lumbar interbody fusion, posterior ligament complex can decrease the incidence of adjacent segment degeneration.