单节段腰椎后路融合术后邻近节段退变的临床研究

Clinical Research of Adjacent Segment Degeneration after Single Level Posterior Lumbar Fusion Surgery

目的:研究单节段腰椎后路融合术后邻近节段椎间盘高度的变化及其影响因素。方法:选取笔者所在医院2010-2012年行单节段腰椎后路融合术患者49例,收集患者术前、术后及随访所摄腰椎正侧位平片,观察对比术后邻近节段椎间盘高度的变化;对不同螺钉大小植入组临近椎间盘高度及其变化进行对比;比较术后及末次随访日本骨科协会(JOA)评分的差异。结果:单节段腰椎后路融合术后邻近椎间盘高度均有不同程度降低,末次所测明显小于术后即时所测(P<0.05);相同节段上下临近椎间盘高度变化不明显(P>0.05);不同螺钉大小植入组临近椎间盘高度变化亦不明显(P>0.05);患者术后JOA评分明显低于末次随访评分(P<0.05),并未因固定节段不同及不同螺钉植入组而出现明显差异。结论:单节段腰椎后路融合术后邻近节段椎间盘退变明显,术后时间越长越显著;同一节段固定融合区上、下方邻近节段椎间盘退变风险之间无明显差异;不同螺钉植入组邻近节段椎间盘退变风险之间无明显差异;腰椎融合术后效果明显,术后近期临近节段退变的发生并未明显影响患者生活质量。

0bjective：To observe the changes of the height of intervertebral discs in the adjacent segments after single level posterior lumbar fusion surger and the impact factors.Method：49 patients who underwent single level posterior lumbar fusion surgery were enrolled during 2010-2012 to investigate and contras the changes of height of intervertebral discs in the adjacent segments through the analysis of their X-ray films.The height and the changes of height of intervetebra discs of different angle groups were compared.The JOA（Japanese Orthopedic Association） scores of the postoperative and the last follow-up evaluation were analyzed Result：The height of the discs in the adjacent segments decreased obviously,especially evidently in the last follow-up（P〈0.05）.The changes of the height betwee the upper and lower adjacent intervertebral discs in the same segment showed no obvious difference（P〉0.05）.The changes of the height of adjacent intervertebra discs in the different angle groups had no obvious difference（P〉0.05）.JOA scores of postoperative evaluation significantly lower than the last follow-up（P〈0.05）there was no significant differences for different fixed segments and angle groups.Conclusion：The adjacent segment degeneration after single level posterior lumba fusion surgery is evidently,the longer the more apparently.There shows no discrepancy on the risk of degeneration between segments adjacent to the fusional area and different angle groups.The advantages of the operation are apparently,the quality of life of patients are not obviously effected by the degeneration recently.