腰椎单侧固定与术后侧弯的相关分析  

Analysis between posterior unilateral pedicle screw fixation plus lumbar interbody fusion and post- operative scoliosis

作　　者：崔尚斌[1] 韩凯[1] 刘少喻[1] 贺平[1] 魏富鑫[1] 王乐[1] 陈宁宁 钟锐[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州市中山二路58号510080

出　　处：《中国矫形外科杂志》2015年第19期1740-1746,共7页Orthopedic Journal of China

摘　　要：[目的]探求后路经椎弓根腰椎单侧固定与术后脊柱侧弯之间的关系。[方法]回顾性分析本科行后路经椎弓根腰椎单侧固定术患者45例。按照手术方式分成两组:A组为后路椎间盘摘除+单侧腰椎椎弓根钉内固定+椎间融合器(Cage)置入植骨融合术;B组为A组术式+对侧关节突关节植骨融合术。比较两组在术前和术后末次随访时下腰痛JOA评分、融合节段骨性融合情况、术后侧弯发生率、Cobb角、融合节段椎间隙高度、邻近节段椎间盘高度等的变化情况,分析术后侧弯发生情况及产生原因。[结果]A组发生轻度术后侧弯2例,发生率8.33%;B组无术后侧弯。两组间术后JOA评分、术后侧弯发生率、椎间植骨融合率、融合节段椎间隙的高度等差异无统计学意义。A组术前与术后Cobb角差异有统计学意义。A组固定侧和对侧的椎间隙高度的差异在术前和术后均无统计学意义。A组固定侧邻近节段的椎间盘高度在术前和术后的差异有统计学意义。[结论]后路经椎弓根腰椎单侧固定术会产生轻度术后侧弯,发生率8.33%。行对侧关节突关节植骨融合组术后Cobb角变化较小。术后脊柱结构不对称和固定侧邻近节段椎间盘的高度变化是术后侧弯发生的主要原因。[Objective] To analyze the relationship between posterior unilateral pedicle screw fixation plus lumbar interbody fusion and post- operative scoliosis. [Methods] We retrospectively analyzed 45 patients who underwent unilateral pedicle screw fixation plus lumbar interbody fusion in our department. The patients were divided into two groups according to the surgical methods they received. Group A received posterior unilateral pedicle screw fixation plus lumbar interbody fusion. Group B received posterior unilateral pedicle screw fixation plus lumbar interbody fusion and contralateral articular process fusion. The difference of low back pain JOA score,bony fusion rate,incidence of post- operative scoliosis,Cobb angle,the height of intervertebral space of fusion level and the adjacent disc height between the two groups were compared respectively. [Results]Two patients in Group A got mild post- op lumbar scoliosis. The incidence was 8. 33%. No patient in Group B got post- op scoliosis. There was no significant difference in JOA score,the incidence of post- op scoliosis,the height of intervertebral space of fusion level and the bony fusion rate between the two groups. There was significant difference in the Cobb angle of group A compared to in group B. There was significant difference in the adjacent disc height change of operation side between groups. There was no significant difference in the adjacent disc height of contralateral side. [Conclusion] Posterior unilateral pedicle screw fixation plus lumbar interbody fusion may cause post- op scoliosis. There is mild change in the Cobb angle of posterior unilateral pedicle screw fixation plus lumbar interbody fusion and contralateral articular process fusion. The asymmetric structure of the spine and change of adjacent disc height are the main factors causing post- op scoliosis.

关 键 词：腰椎 椎弓根钉 椎间融合 单侧 术后侧弯 

分 类 号：R687.3[医药卫生—骨科学]