腰椎融合节段数与术后相邻节段退变及远期疗效的关系  

Correlation between fusion segment number of lumbar vertebra and postoperative adjacent segment degeneration and long term curative effect

作　　者：赵宇[1] 杨开舜[1] 李绍波[1] 

机构地区：[1]大理学院附属医院外三科,云南大理671003

出　　处：《西南国防医药》2013年第4期388-391,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨腰椎融合术融合节段数目与临床效果及术后相邻节段退变的关系。方法回顾性分析2005年6月～2009年6月本院骨科行后路椎弓根螺钉固定并椎间及后外侧植骨融合术的135例患者的临床资料,并依据腰椎融合节段数分为3组,A组56例为单节段融合,B组42例为双节段融合,C组37例为多节段融合(≥3个节段),对3组术后的远期疗效、相邻节段退变情况进行比较分析。结果 3组术后随访时间分别为(2.6±0.3)年、(2.3±0.5)年和(2.4±0.5)年(P>0.05),C组末次随访时ODI指数和椎间隙高度分别为(23.5±9.4)%和(0.64±0.07)cm,显著高于其他两组;135例中,共19例融合节段近端邻近节段发生继发性退变,其中A组5例(8.9%),B组6例(14.3%),C组8例(21.6%),C组发生率高于A组,但差异不显著(P>0.05);A组5例UCLA增加1级,B组4例增加1级,1例增加2级,1例增加3级,C组1例增加1级,4例增加2级,3例增加3级,UCLA增加2级、3级时,C组显著高于其他两组(P<0.05);A组5例ASD患者中,3例疗效未发生改变,2例下降1级;B组6例中,2例未发生改变,3例下降1级,1例下降2级;C组8例中,1例未发生改变,3例下降1级,4例下降2级,疗效下降2级时,C组显著高于其他两组(P<0.05)。结论腰椎融合术融合节段数目与术后近端脊柱节段继发性退变存在一定的关联,特别是多节段融合,术后ASD的发生率最高,且远期疗效较差,临床上应尽量避免多节段融合术的使用。Objective To investigate the correlation between fusion segment number of lumbar vertebra and clinical effects and postoperative adjacent segment degeneration. Methods Retrospective analysis was made in the clinical data of 135 patients undergoing post approach screw fixation of vertebral pedicle and posterolateral bone graft fusion in our hospital from June 2005 to December 2011. According to the number of lumbar fusion segments, those patients were divided into three groups. Group A was single segment fusion（56 cases） ;group B was double segments fusion（42 cases） ;groups C was multi - segments fusion（ ≥ 3 segments, 37 case）. Comparison and analysis were made in the long term curative effect and adjacent segment degeneration among the three groups. Results The postoperative follow - up time for the three groups was （2.6 ±0.3 ） years, （2.3 ±0.5 ） years, and （2.4 ± 0.5 ） years, respectively（ P 〉 0.05 ）. The ODI index and intervertebral height of group C at the last time of follow - up was （23.5 ± 9.4 ）% and （0.64 ±0.07）cm,respectively,which were all higher than those of the other two groups. Among the 135 cases, ASD occurred in 19 patients including 5 ones in group A（8.9% ） ,6 ones in group B（ 14.3% ） ,and 8 ones in group C（21.6% ）. The incident in group C was higher than that in group A, however, the difference was not significant（P 〉 0.05）. In group A, the UCLA increased by 1 grade in 5 cases ;in group B, that increased by 1 grade in 4 cases, by 2 grades in one case, and by 3 grades in one case; in group C, that increased by 1 grade in one case, by 2 grades in 4 ones, and by 3 grades in 3 ones. When the UCLA increased by 2 - 4 grades the incidence in group C was significantly higher than those in the other two groups （P 〈 0.05 ）. Among the 5 cases of ASD in group A, curative effect did not change in 3 ones and decreased by 2 grades in one. Among the 6 cases in group B, that did not change in two, decreased by 1 grade in three, and decreased by

关 键 词：腰椎融合 内固定 退变 节段 

分 类 号：R681.57[医药卫生—骨科学]