T1ρ-MRI技术评价腰椎不同内固定方式对相邻节段椎间盘退变的影响  

Analysis of Adjacent Segment Disease after Different Lumbar Instrumented Fusion by Using Magnetic Resonance T1ρ

作　　者：魏富鑫[1] 钟锐[1] 王乐[1] 刘少喻[1] 崔尚斌[1] 潘希敏[2] 孙海兴[2] 黄阳亮[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广东广州510080 [2]中山大学附属第一医院放射科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2014年第4期545-551,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金-广东联合基金(U1032001);广东省科技计划项目(2010B031600203);广东省自然科学基金(S2013010015775);广州市黄埔区科技支撑计划(201329-04)

摘　　要：【目的】应用T1ρ-MRI技术定量评价后路腰椎椎间融合固定术(PLIF)与棘突间动态固定术(wallis)对相邻节段椎间盘退变的影响,并分析退变的相关因素。【方法】通过前瞻性研究方法,选取L4/5退变性失稳患者42例,按随机数字法将患者随机分为PLIF组和Wallis组,分别为22例和20例。通过T1ρ-MRI技术以及拍摄X线片,测量固定节段上位相邻节段椎间盘髓核T1ρ值、椎间盘高度、椎间隙动态角度变化,并通过JOA评分及腰功能障碍指数(ODI)评价临床效果。终末评估时间设为术后24个月。【结果】42例患者均获得随访,Wallis组手术时间及出血量均少于PLIF组,且差异有统计学意义(P<0.05)。末次随访,两组ODI、JOA评分改善率以及L3/4节段影像学退变率均无显著性差异(P>0.05);但两组L3/4椎间盘T1ρ值末次随访均存在下降趋势,且PLIF变化值明显大于Wallis组,差异有统计学意义(P<0.05)。【结论】与PLIF术式相比,棘突间动态固定(Wallis)具有出血少、用时短等优点,且可显著延缓上位相邻节段椎间盘髓核中PG退变趋势,但两者临床效果无显著性差异。[Objective]To compare the influence of posterior lumbar interbody fusion and wallis interspinous implant on adjacent segment disease,and investigate if the wallis interspinous implant could reduce the adjacent segment disease.[Methods]Overall 42 patients with L4/5 degenerative instability were enrolled in this respective study.According to a simple randomized study,22 patients were treated with posterior lumbar interbody fusion,while 20 patients were managed with wallis interspinous implant.The vertebral height,dynamic intervertebral angle,displacement of slippage of the cranial adjacent segment and T1 ρ value of nucleus pulposus of L3/4 were measured and compared preoperatively,postoperatively and the final follow-up by using magnetic resonance （MRI） and X ray.The clinical results were assessed and compared by using JOA score and Oswestry dysfunction index （ODI）.[Results]All patients were followed up successfully.The blood loss and operative duration of wallis group were significantly less than that of PLIF group,respectively.There were no significant differences of the recovery rate of ODI,JOA and radiological degenerative rate of L3/4 between the two groups （P 〉 0.05） at final follow-up.The Tiρ value of nucleus pulposus of L3/4 decreased in both of the two groups at final follow-up,moreover,the PLIF group decreased more significantly than the wallis group （P 〈 0.05）.[Conclusion]The interspinous （wallis） fixation can decrease the cranial adjacent segment degeneration with less blood loss and operative duration than the PLIF with pedicle screw fixation,however,there are no significant difference of clinical results between the two methods.

关 键 词：磁共振 相邻节段 椎间盘退变 内固定 腰椎 

分 类 号：R686[医药卫生—骨科学]