腰椎融合后邻近节段影像学评估方法的应用随访  

Follow-up application of imaging evaluation on adjacent lumbar segment after instrumented posterior spinal fusion

作　　者：吴超[1] 魏剑[1] 王清[2] 谭伦[1] 黄迅[1] 唐玉湖[1] 

机构地区：[1]四川省自贡市第四人民医院骨科,四川省自贡市643000 [2]泸州医学院附属医院脊柱外科,四川省泸州市646000

出　　处：《中国组织工程研究与临床康复》2011年第52期9782-9786,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：四川省卫生厅科学研究项目(080424)~~

摘　　要：背景：目前多数研究只分析了脊柱融合治疗紧邻融合区域头尾侧节段的术后改变,未对其他紧邻内固定的未作融合节段进行对照研究。目的：探讨腰椎邻近节段的测量方法,对腰椎后外侧融合后邻近节段的改变进行长期随访影像学评估。方法：选取尸体骨架6具,以不同投照方式和标本位置行腰椎侧位数字化标准X射线片共计42次（每具标本投照7次）。随访57例腰椎后外侧融合患者,随访时间1.5~4年,拍摄融合前及末次随访时的数字化标准X射线片,所有资料用失真代偿X射线分析法测量椎体间矢状角度、椎间盘高度、椎体间前后移位。结果与结论：失真代偿X射线分析法测量邻近节段矢状曲度、椎间盘高度、椎体间前后移位时,不同投照方式比较差异均无显著性意义（P〉0.05）。固定节段尾侧椎体间未发现显著的影像学改变,固定节段头侧的多个椎体间矢状角度、椎间盘高度均有明显的改变。提示腰椎后外侧融合后影像学的改变提示固定节段头侧多个椎间盘加速退变。BACKGROUND： Now, most studies related to adjacent segment degeneration only analyze the changes of motion segments above and below the fusion. There were no controlled studies on adjacent segments to all the other unfused segments after instrumented posterior fusion. OBJECTIVE： To study measurement of adjacent lumbar segments and evaluate long-term radiographic changes in all adjacent lumbar segments after instrumented posterolateral lumbar fusion. METHODS： Totally 42 digitized radiographs of lateral lumbar spine from 6 corpse skeletons were obtain through different projections and specimen postures （every specimen with 7 projection）. Fifty-seven patients with posterolateral lumbar fusion were followed-up from 1.5 to 4 years. Digitized radiographs of them were photographed before fusion surgery and final follow-up. Distortion-compensated roentgen analysis （DCRA） method was used to measure sagittal angle, disc height, and dorsoventral displacement in all the above data. RESULTS AND CONCLUSION： There were no statistical significance in sagittal angle, disc height, and dorsoventral displacement under different postures by using DCRA method （P 0.05）. No changes were observed at the segments located below the fusion. All the unfused segments above the fusion showed significant changes of sagittal angle and disc height. It is indicated that the radiographic changes of posterolateral lumbar fusion suggest the disc degeneration of the segments above the fusion.

关 键 词：腰椎 融合 邻近节段 退行性改变 X射线片 

分 类 号：R318[医药卫生—生物医学工程]