腰椎融合术后邻近节段退变的诊治与近期疗效观察

Diagnosis and treatment of adjacent segment degeneration post-operation of lumbar fusion and its short-term effect

目的探讨腰椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的诊断与治疗,并评估其近期疗效。方法回顾性分析2013年5月-2018年7月在本院经腰椎后路减压椎间融合术后因邻近节段退变再发腰腿痛症状的患者52例,其中男性29例,女性23例,平均年龄(57.3±7.4)岁。所有患者均予以保守治疗或手术,采用JOA评分及JOA改善率、VAS评分、ODI指数等进行疗效评价。结果经正规保守治疗6个月,其中17例疗效显著;另35例因疗效较差而改行手术,手术时间为(117.3±16.5) min,术中失血量(227.2±48.6) mL,术后引流量为(319.5±53.7) mL。随访(13.6±4.9)个月,手术患者的JOA评分改善率为(76.18±7.69)%,术后及末次随访时的JOA评分、VAS评分、ODI指数与术前比较,均获显著改善(P<0.05)。3例患者术后出现脑脊液漏,2例出现神经病理性疼痛,余无感染、医源性神经损伤等并发症。结论 ASD是腰骶椎融合后远期重要并发症之一,部分病例可通过正规保守治疗取得良好疗效,但仍以再次手术为主要治疗方案,术后可取得良好疗效。

Objective To investigate the diagnosis and treatment of adjacent segment degeneration (ASD) post-operation of lumbar fusion and evaluate its short-term effect.Methods A retrospective analysis was performed in 52 patients who suffered back and leg pain due to ASD after lumbar fusion in our hospital from May 2013 to July 2018,including 29 males and 23 females.with an average age of (57.3±7.4) years.All patients received conservative therapy or surgery.The JOA score and JOA improvement rate,VAS score,ODI index were used to evaluate the curative effect.Results After 6 months of regular conservative treatment,17 cases had significant effect.Another 35 patients underwent surgery due to poor efficacy.The operation time was (117.3±16.5) min,intraoperative blood loss was (227.2±48.6) m L,and postoperative drainage volume was (319.5 ± 53.7) m L.All patients were followed up for (13.6 ± 4.9)months.The JOA score improvement rate of the surgical patients was (76.18±7.69) %.The JOA score,VAS score and ODI index after operation and at the last follow-up were significantly improved compared with before operation (P< 0.05).Cerebrospinal fluid leakage occurred in 3 patients,neuropathic pain occurred in 2 patients,and there were no other complications such as infection and iatrogenic nerve injury.Conclusion ASD is one of the important long-term complications after lumbosacral fusion,and some patients can achieve good efficacy through regular conservative treatment,but reoperation is still the main treatment plan,and good efficacy can be achieved after surgery.