腰椎融合术后椎体硬化和骨赘的变化

Fate of Osteophytes and Sclerosis in Fusied Segments after Lumbar Fusion

目的 回顾性分析腰椎退行性疾病行融合术后相应节段椎体硬化和前缘骨赘的变化。方法 将30例患者共60个椎体纳入研究,其中男性9例,女性21例;年龄45~86岁,平均（66.8±11.2）岁。根据术式将患者分为后外侧融合术（posterolateral fusion,PLF）组和后路椎间融合术（posterior lumbar interbody fusion,PLIF）组,其中PLF组14例,共28个椎体;PLIF组16例,共32个椎体。分别在术前及术后第3、6、12、24个月和末次随访时拍摄腰椎侧位片,测量各时间点受累节段上下椎体的硬化区面积和骨赘长度。结果 腰椎融合术后对应的硬化区面积和骨赘长度随着时间逐渐减小,这种改变在术后3个月时即可观察到,而在0~3个月和3~6个月随访区间内减少幅度最显著;在PLF组和PLIF组内骨硬化和骨赘的变化情况相似。结论 腰椎融合术后可观察到椎体硬化区和前缘骨赘的吸收,而且最显著的吸收发生在术后3个月和6个月内。

Objective To investigate the fate of sclerosis and anterior osteophytes in the fused segments after instru-mented lumbar fusion for degenerative lumbar disorders.Methods Thirty patients （9 males,21 females;60 vertebra;mean age of 66.8 years（45~86 years）were divided into a posterolateral fusion group （n=14,28vertebrae）and a poste-rior lumbar interbody fusion group（n= 16,32 vertebrae）.Serial radiographs obtained preoperatively;postoperatively at 3,6,12 and 24 months;and last follow-up,sclerotic areas of each involved vertebra were mapped and osteophyte lengths were measured.Results Sclerosis and osteophytes decreased with time for the instrumented fusion.The decrease in sclerotic areas and osteophytes length was observed as early as 3 months postoperatively;and the significant change be-tween each time point were noted in initial 3-and 6-month intervals.In terms of the type of surgery,similar changes were noted in the posterolateral fusion and posterior lumbar interbody fusion groups.Conclusion Resorption of osteo-phytes and sclerosis after instrumented spine fusion were observed.Significant resorption was noted at 3 and 6 months postoperatively.Resorption of osteophytes and sclerosis after instrumented spine fusion could be helpful to confirm the successful union.