退变性腰椎滑脱融合术后邻近节段椎间盘退变的远期观察  

Long-term observation on adjacent segment disc degenerationafter fusion in degenerative lumbar spondylolisthesis

作　　者：姜欢畅 王吉兴[2] 杨晓东 赖震 吴建群 刘志祥 JIANG Huan-chang;WANG Ji-xing;YANG Xiao-dong;LAI Zhen;WU Jian-qun;LIU Zhi-xiang(Department of Orthopaedics,Huadu Hospital Affiliated to Southern Medical University,Guangzhou 510800;Department of Spine Surgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学附属花都医院(广州市花都区人民医院)骨一科,广东广州510800 [2]南方医科大学南方医院脊柱骨科,广东广州510515

出　　处：《颈腰痛杂志》2021年第4期512-515,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察退变性腰椎滑脱融合术后邻近节段椎间盘的远期退变情况。方法分析62例退变性腰椎滑脱患者融合术后5~9年的影像学资料,其中单节段融合37例,多节段融合25例,根据Pfirrmann系统对融合的邻近节段椎间盘进行退变分级,对单节段和多节段融合的邻近节段、融合的近侧和远侧节段椎间盘退变情况及JOA评分进行比较和统计学分析。结果融合的近侧和远侧节段椎间盘退变分级差异有统计学意义(P<0.05),近侧比远侧节段退变更明显;多节段和单节段融合术后邻近节段椎间盘退变分级差异有统计学意义(P<0.05),多节段比单节段更严重。末次随访时,单节段融合组的JOA评分显著高于多节段融合组(P<0.05)。结论退变性腰椎滑脱融合术可引起邻近节段椎间盘退变,最好选择单节段和远侧节段融合,尽量避免多节段和近侧节段融合。Objective To observe the long-term situation of adjacent segment disc degeneration after fusion in patients with degenerative lumbar spondylolisthesis.Methods Sixty-two degenerative lumbar spondylolisthesis patients after fusion 5 to 9 years were retrospectively analyzed.37 cases were treated with single segmental fusion and 25 cases were treated with multiple segmental fusion.Grades about adjacent segment disc degeneration were carried out according to the Pfirrmann system.The grades and JOA score of these patients were analyzed and compared between single and multiple segmental fusion,proximal and distal sides of the fusion segment.Results The difference of intervertebral disc degeneration grades was statistically significant between proximal and distal sides of the fusion segment(P<0.05),also was statistically significant between single and multiple segmental fusion(P<0.05).Proximal side of the fusion segment degenerated more obviously than distal.Multiple segmental fusion degenerated more seriously than single.The JOA score of the single-segment fusion group was higher than that of the multi-segment fusion group at the last follow-up(P<0.05).Conclusion The fusion surgery on degenerative lumbar spondylolisthesis can cause adjacent segment disc degeneration.It is better to choose single-segment and distal segment fusion,and try to avoid multi-segment and proximal segment fusion.

关 键 词：腰椎 脊椎前移 脊柱融合术 邻近节段退变 

分 类 号：R274.1[医药卫生—中医骨伤科学]