腰椎滑脱椎弓根螺钉内固定融合术后邻近节段退变的相关研究  

Study of adjacent segment degeneration after internal fixation lumbar fusion with pedicle screw

作　　者：赵文国[1] 沈冰[1] 张柳[1] 王勇贵[1] 贾鹏[1] 

机构地区：[1]华北煤炭医学院附属医院骨外科,河北省唐山市063000

出　　处：《中国综合临床》2008年第6期542-544,共3页Clinical Medicine of China

基　　金：河北省卫生厅课题（07348）

摘　　要：目的探讨腰椎内固定融合术后邻近椎间盘高度的变化及其与螺钉角度的关系。方法对行腰椎内固定融合术的腰椎滑脱患者31例进行回顾性研究，观察术后固定融合区邻近椎间盘的变化；对是否“悬浮固定”对邻近椎间盘高度变化的影响以及不同邻近节段椎间盘高度变化进行对比；分析邻近椎间盘高度变化与螺钉角度的关系。结果随访10～16个月，平均13．5个月。①L5～S1固定组其上方的L4＼L5椎间隙术后1年高度与术后即时相比虽有一定程度的降低，但差异无统计学意义（P〉0．05）；L4～L5固定组其上方的L3＼L4椎间隙及下方的L5＼S1椎间隙术后1年高度与术后即时相比虽都有一定程度的降低，但差异亦无统计学意义（P〉0．05）；②L5-S1固定组其上方的L4＼L5椎间隙高度变化与L4/L5固定组其上方的L3＼L4椎间隙高度变化相比较，差异无统计学意义（P〉0．05）；③L4～L5固定后，固定融合区上方邻近椎间隙（L3＼L4）高度变化与下方邻近椎间隙（L5＼S1）高度变化相比较，差异无统计学意义（P〉0．05）；④把手术组按螺钉角度大小分为2组（C组〈6°，D组〉6°），将2组固定融合区上方邻近椎间隙高度变化进行比较．差异无统计学意义（P〉0．05）；（5）将手术组固定融合区上方椎间隙高度变化与螺钉角度进行相关分析后发现．二者之间存在正线性相关关系（r=0．373，P=0．039）。结论①是否“悬浮固定”对固定融合区邻近节段椎间盘退变的影响没有差异；②固定融合区上、下方邻近节段椎间盘退变风险无差异；③螺钉角度的大小对固定融合区上方邻近节段椎间盘退变有影响，二者存在正相关关系，即螺钉角度越大，椎间盘退变越明显。Objective To observe the changes of the height of intervertebral discs of the segments adjacent to the fusional and instrumental area after the operation and the relation between the changes of height of intervetebral discs in the adjacent segments and the angle of the pedicle screw. Methods Thirty-one patients who underwent internal fixation from September 2004 to March 2006 were retrospectively analyzed. The intervertebral discs height of adjacent segment was studied. The influence of ＂ Suspensory fixation＂ on the changes of height of adjacent intervertebral discs was compared. The relation between the changes of the height of the upper adjacent intervertebral discs and the angle of pedicle screw was analyzed. Results The mean follow-up period for the patients was 13.5 months （ 10- 16 months）. In the operating-group, the height of the adjacent intervertebral disc decreased slightly, but the changes had no statistical significance （ P 〉 0.05 ）. Between the group fixed between L5 and S1 and group fixed between L4 and Ls, the changes of the height of the upper adjacent intervertebral discs had no obvious difference （ P 〉 0.05）. In the group fixed between L4 and L5 , there had no obvious difference between the changes of the height of the upper adjacent intervertebral discs and the changes of the height of the lower one （ P 〉 0.05 ）. When the operating-group were divided into two groups according to the angle of pedicle screw （ 〈 6°or 〉 6°） ,the changes of the height of the upper adjacent intervertebral discs had no obvious difference （ P 〉 0.05 ）. But there had positive and correlative relation between changes of the height of the adjacent intervertebral discs and the angle of pedicle screw （ r = 0.373 ,P = 0.039 ）. Conclusion ＂Suspensory fixation＂ has no different influence on the changes of height of adjacent intervertebral discs. There has no difference on the risk of degeneration between upper and lower segment adjacent to the fusional area. There has positive

关 键 词：腰椎 内固定 融合 椎间盘 退变 

分 类 号：R687.3[医药卫生—骨科学]