Topping-off术后上位相邻节段的MRI表现及近期疗效  

MRI manifestation of upper adjacent disc and short-term clinical outcomes after topping-off surgery

作　　者：曹亮亮[1] 徐建广[1] 连小峰[1] 蔡斌[1] 杨二柱[1] 张国旺[1] 

机构地区：[1]上海交通大学附属第六人民医院脊柱外科,上海200233

出　　处：《中国矫形外科杂志》2017年第17期1552-1557,共6页Orthopedic Journal of China

基　　金：上海市市级医院新兴前沿技术联合攻关项目(编号:SHDC2014102)

摘　　要：[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P<0.01),但相同时间点两组间的差异无统计学意义(P>0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P<0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。[Objective] To evaluate the changes of the upper adjacent disc on MRI and the short-term clinical outcomes after topping-off surgery with implanting Coflex. [Methods] From August 2007 to November 2014, 107 patients who suffered from L5S1 disc prolapse combined with L4.5 disc degeneration, were treated surgically and followed up ≥2 years in our hospital were included into this study. Of them, 48 patients received only posterior lumbar interbody fusion at L5S1 level （the fusion group） , while the other 59 patients had topping-off surgery, L5S1 fusion combined with L,. 5 interspinous Coflex insertion （the topping-off group） . The visual analog scale （VAS） , Oswestry disability index （ODI） score and relative signal intensity （RSI） at L. 5 disc on MRI were recorded and compared between the two groups. [Results] In term of clinical symptoms, the VAS and ODI in both groups significantly decreased at the latest follow-up compared with those before operation （P〈0.01） . but there were no significant differences in any score at corresponding time points between the two groups （P 〉 0.05） . Regard- ing to the disc degeneration, the RSI at L4,5 disc on MRI in the topping-off group was significantly higher than the fusion group at the latest follow up, showed a statistical difference （P〈0.05） . [Conclusion] Both topping-off surgery and fusion surgery achieve satisfactory clinical outcomes. However, for the patients with upper adjacent degeneration, the topping-off surgery has potential to decrease the degeneration of the adjacent discs.

关 键 词：Topping-off MRI 相对信号强度 相邻节段 融合 

分 类 号：R687.3[医药卫生—骨科学]