腰椎椎体间融合固定术后上位相邻椎间变性和腰椎形态关系探讨.docVIP

腰椎椎体间融合固定术后上位相邻椎间变性和腰椎形态关系探讨 　　[摘要] 目的 将使用内固定器械在后路腰椎固定术中出现上位临近椎间变性的病例和没出现的病例就腰椎形态进行比较。 方法 回顾性分析2010年7月～2013年8月手术并有2年以上随访时间的25例患者的临床资料。男14例，女11例，平均年龄61.2岁，术后随访时间24～87（38.8±17.1）个月。使用术前的X线和CT影像，最后随访时单纯的X线影像进行评价。 结果 7例被确认上位相邻椎间变性，术后固定的椎间隙抬高明显要大。另外退变的椎间关节角度虽然呈现比较大的倾向，但差异无统计学意义（P0.05）。 结论 固定节段椎间隙的过度抬高是加速相邻节段椎间退变的危险因素，术中要有所注意。 　　[关键词]腰椎椎体间融合;相邻椎间;椎间抬高;椎间关节角 　　[中图分类号] R681.5 [文献标识码] B [文章编号] 2095-0616（2015）02-192-04 　　An investigation of the relationship between upper adjacent intervertebral degeneration after surgery of lumbar confluent fixation and lumbar form 　　ZHOU Wei HE Xiaobin 　　Department of Orthopedic， the First Peoples Hospital of Jingzhou City in Hubei Province， Jingzhou 434000， China 　　[Abstract]Objective The cases of upper adjacent intervertebral degeneration in lumbar confluent fixation by using instrument of internal fixation and lumbar form were compared. Methods 25 cases of surgical patients with more than two years of follow-up time period from July 2010 to August 2013 were retrospectively analyzed. 14 males and 11 females， mean age was 61.2 years old， were followed up for 24 to 87 （38.8±17.1） months. Preoperative use of X-ray and CT imaging， the last pure X-ray images were evaluated during follow-up. Results Seven cases were confirmed of upper adjacent intervertebral degeneration， and the intervertebral space after a fixed elevation was significantly larger. Another facet degeneration， although the angle exhibits relatively large tendency， but had statistically significant differences. Conclusion Excessive elevation of intervertebral fixed segment is a risk factor of acceleration intervertebral adjacent segment degeneration， should be attention intraoperation. 　　[Key words] Adjacent intervertebral; Lumbar interbody fusion; Intervertebral elevation; Intervertebral joint elevation angle 　　在脊柱外科领域内固定器械的普及是有目共睹，使用在各种各样的脊柱手术中。对于腰椎退变性疾病的后侧方固定术也有使用内固定器械。其优点有术后可早期离床，骨愈合率提高，术后外固定装具可简化，变形的矫正得以保持，能早期稳定或预防椎体间不稳定性等已有很多报道[1-2]。内固定术后产生相邻节段的椎间变性或不稳定的报道也不少见[3-5