Topping-off术后腰椎上位相邻节段退变的影像学分析  

Imaging analysis of adjacent segment degeneration on upper lumbars after topping- off technology

作　　者：许有银[1] 朱震奇[2] 刘海鹰[2] 钱亚龙[2] 王凯丰[2] 王会民[2] 王波[2] 

机构地区：[1]民航总医院骨科,北京市朝阳区朝外高井甲1号100123 [2]北京大学人民医院脊柱外科,北京市西直门南大街11号100044

出　　处：《中国矫形外科杂志》2014年第7期577-583,共7页Orthopedic Journal of China

基　　金：北京市科委课题腰椎管狭窄症手术治疗规范的制定(编号:D101100049910006;课题负责人:刘海鹰教授);国家自然科学基金研究课题"植入式膀胱功能修复芯片与相关机制研究"(编号:61076023;课题负责人:刘海鹰)

摘　　要：[目的]研究不同方式腰椎后路短节段融合术后上位相邻节段退变（adjacent segment degeneration．ASD）的影像学变化特点。[方法]回顾分析本科2008年6月～2010年9月间所有行L4，后路椎间融合术（posterior lumbar interbody fusion，PLIF）＋L3,4棘突间动态稳定手术（interspinous spacers，ISPs）病例共22例（Topping—off组，简称T组。Topping-off手术，即加顶技术，指PLIF联合近端节段ISPs手术），2007年1月-2008年5月间行L3-5，PLIF手术者共30例（Rigid Fixation组，简称R组）。采集患者围手术期数据，测量两组术前和末次随访时腰椎侧位X线片及过屈、过伸侧位x线片和MRI片，用统计软件SPSS19．0进行统计分析。[结果]两组患者性别、年龄、体重指数（Body Mass Index，BMI）、随访时间、围手术期情况差异均无统计学意义（P〉0．05）。侧位x线片两组L，，椎间隙前缘高度均略有增加、后缘高度和平均高度均略有降低、腰椎前凸角均增大，T组与R组间无显著统计学差异（P〉0．05）；腰椎前凸角度T组自身比较差异有统计学意义（P〈0．05）；L2，3椎间隙中立位角度和过伸位角度均增大、R组增大较T组有显著统计学差异（P〈0．05）。L2、3椎间隙过屈位角度和活动度（Range of Motion，ROM）均增大，R组与T组间比较差异无统计学意义（P〉0．05），过屈位角度R组内比较差异有统计学意义（P〈0．05）。x线片T组L2无影像学征象；R组有1例L2,3椎间盘高度下降〉20％，2例L2,3椎问ROM〉10°，诊断为影像学ASD。末次随访时，T组MRIT2相L2．3椎问盘改良Pfirrmann分级有2例升高1级，R组有8例升高1级、2例升高2级（包含x线片诊断ASD的3例），两组间差异有统计学意义（P〈0．05）。[结论]后路短节段Topping-off手术和PLIF手术的安全性和创伤性相似；术后2—5年内，Topping—off手术与PLIF手术相比，可能有助于延缓相邻节段�[ Objective] To investigate the early- middle stage clinical results of topping- off surgery in preventing adjacent segment degeneration when there is an pre -existing mild intervertebral disc degeneration. [ Methods] We retrospectively analyzed all the cases that received L4.s PLIF ＋ L3,4 ISPs （ interspinous spacers, include Wallis and Coflex surgery between June, 2008 and September, 2010, and adopted them as group T （T for topping - off ） . We retrospectively analyzed all the ca- ses that received L3_5 PLIF surgery between January, 2007 and May, 2008, and adopted them as group R （R for rigid fixa- tion）. We selected the cases that rated their L2,3 intervertebral disc degeneration under Grade IV by modified pfirrmann grading syestem as the same time the followed -up time minimum two years. [ Results ] Twenty - two patients in group T and 30 patients in group R were included in tile final analysis. There was no significant difference in the length of follow - up, gender, age, BMI, pre - operation gradings, surgery time, blood loss, or postoperation drainage （ P 〉 0.05 ） . No symptomatic adjacent segment degeneration was observed. In the lateral view of lumbar spine of the two group, the average value of anterior disk height, segmental lordosis of L2.3 and total lordosis were all increased, in which segmental lordosis of L2.3 was significantly changed （ P 〈 0.05 ） . However, posterior and mean disk height were all decreased, unsignificantly （ P 〉 0. 05 ） . In the hyperextension and hyperflexion view, in group T and R, lordosis of L2,3 and range of motion （ROM） were all increased, in which the Lz,3 lordosis in hyperextension view changed significantly （P 〈 0. 05） . In group R, lordosis of L2,3 in hyperflexion view was changed significantly （P 〈 0. 05）. In the magnatic resonance imaging T2 view, the grade of L2.3 intervertebral disc degeneration by modified Pfirrmann was increased significantly in group R （P 〈 0. 05 ） . [ Conclusion] Topping - off surgery on L3-5 s

关 键 词：邻近节段退变 棘突间动态稳定 椎间融合 非融合 

分 类 号：R687.3[医药卫生—骨科学]