腰椎内固定融合后L_(3-4)节段邻近节段病变与性别的关系

Correlation of adjacent segment disease of L_(3-4) and gender after lumbar fusion

背景:腰椎的结构复杂,腰椎内固定融合后会出现关节突肥大性关节炎,关节退行性病变和节段性不稳定等,严重影响治疗效果。为了防止邻近节段关节发生病变,近年来临床上已经将过去坚强的融合固定转变为尽量保留活动度的弹性固定,但效果仍不理想。同时目前关于腰椎邻近节段病变的影响因素尚无定论。目的:研究腰椎内固定融合后L_(3-4)节段病变与性别的相关关系并进行探讨。方法:回顾性分析石家庄市第一医院2007至2016年行L_(4-5)、L_5-S1椎间植骨融合后患者200例,按照性别不同分为男性组及女性组,各100例,对比两组的L_(3-4)节段发病情况。结果与结论:与男性患者相比,女性患者不同的融合位置以及融合范围下L_(3-4)节段发生病变情况较多,Oswestry功能障碍指数及目测类比评分较高,且融合部位方位角位移运动范围较大。Logistic回归分析发现,性别是L_(4-5)、L_5-S1腰椎内固定融合后L_(3-4)节段病变独立相关影响因素之一。说明性别是影响腰椎内固定融合后L_(3-4)节段邻近节段病变的因素之一,女性内固定后邻近节段退变风险升高。

BACKGROUND： Because of complicated biomechanics of lumbar vertebra, mast facet osteoarthritis, degenerative joint disease and vertebral subluxation usually occur following lumbar fusion. To avoid adjacent segment disease, researchers have transformed strong internal fixation into elastic fixation, but the treatment outcomes are barely satisfactory. Furthermore, factors involving adjacent segment disease remain unclear. OBJECTIVE： To explore the relationship between L3-4 segment disease following lumbar fusion and gender. METHODS： 200 patients undergoing lumbar fusion of L4-5 and L5-S1 in the First Hospital of Shijiazhuang ranging from 2007 to 2016 were enrolled, and then allotted into male and female groups（n=100 per group） for retrospective analysis. The incidence of L3-4 segment disease was compared between two groups. RESULTS AND CONCLUSION： Compared with the male group, in the female group, the incidence of L3-4 segment diseases at different fusion locations and ranges, the Oswestry disability index and visual analogue scale and each migration range were significantly higher. Logistic regression analysis showed that gender was one of the independent factors of L3-4 segment disease following lumbar fusion of L3-4 and L5-S1. These findings suggest that gender is one of the influencing factors of L3-4 segment disease after instrumented lumbar; thereby, adjacent segment disease occurs frequently in female patients.