腰椎融合术后邻近节段退变的临床观察  

Clinical observation on adjacent segment degeneration after lumbarfusion

作　　者：孟宪中[1] 孟宪国[1] 申勇[1] 董玉昌[1] 张标[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄市050051

出　　处：《河北医药》2006年第7期551-553,共3页Hebei Medical Journal

摘　　要：目的 探讨腰椎融合术后邻近节段退变的特点，以及再手术治疗的术式及疗效。方法 回顾性分析2001年1月至2004年12月我科收治的行腰椎融合术的患者，其中发现18例患者出现了邻近节段退变。采用返修手术对18例患者进行手术处理，将减压及固定融合范围向邻近退变节段延伸，缓解临床症状。按照候树勋等的临床疗效评价标准随访观察。结果 经过12．1个月（7．36个月）的随访，优良率88．9％。有1例患者可再次手术后4个月出现内固定松动脱落，再次手术取出内固定。结论 退变好发于融合节段的上方，应仔细鉴别症状复发是由于前次手术节段引起还是邻近节段退变引起。必要时再手术治疗仍可取得较好的疗效。Objective To investigate the clinical characteristics of adjacent segments degeneration after the first time lumbar fusion, and to study the effects of the second surgical procedure.Methods 18 patients with adjacent segment degeneration after lumbar fusion, admitted in our hospital from January 2001 to December 2004, were studied retrospectively. These patients were treated with the whole vertebral disectomy and the neuclear disectomy and 10 of them were treated with the pedicle screw fixation system. The image study showed that both the segment up and downs had degeneration, and 8 of them showed obvious compress and stenosis. We performed the second operation for these patients. Results Follow-up time after the second procedure was 12.1 months （range 7 -36 months）. The excellent and good rate was 88.9 %. One patient was failure of the interfixation system. Conclusion Adjacent segment degeneration usually occurs above the fusion segments. It is necessary to differentiate the new symptoms whether which is caused by the adjacent degenerative segment or the previous surgery. Satisfactory results may be got by the second op- eration for the patients of adjacent segment degeneration after lumbarfusion.

关 键 词：腰椎 融合术 邻近节段 退变 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]