腰椎融合术后相邻节段旋转角度、椎间活动度及椎间隙高度变化的临床分析

Clinical analysis for change of postoperative adjacent segmental rotation angle, intervertebral motion and intervertebral height

中文关键词:  腰椎  脊柱融合  相邻节段退变  疗效

英文关键词:Lumbar spine  Spinal fusion  Adjacent segments degeneration  Clinical effect

中文摘要:

  【摘要】 目的：利用脊柱云纹系统（DIERS Formetric 4D，Diers International GmbH，Schlangenbad，Germany）和影像学检查评估腰椎固定融合术对相邻节段旋转角度、椎间活动度及椎间隙高度的影响，并探讨预测邻近节段退变的敏感指标。方法：收集2016年1月～2016年6月期间，73例行单节段腰椎后路减压融合固定术患者的临床资料，其中男40例，女33例，平均年龄47.2±10.3岁（40~60岁），手术节段：L2/3 6例，L3/4 10例，L4/5 32例，L5/S1 25例。应用DIERS脊柱云纹系统分别于术前、术后6个月、1年、2年收集并计算融合节段与上、下邻椎旋转角度的差值（相对旋转角度）。术前及末次随访时通过腰椎X线测量相邻节段活动范围（range of motion，ROM）及椎间隙高度（disc height，DH）。末次随访时采用视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者腰腿痛及腰椎功能情况；根据相邻节段有无影像学退变，将患者分为退变组与非退变组并进行对比分析。结果：术前患者融合椎与上、下邻椎相对旋转角度分别为5.2°±2.1°和3.1°±2.1°，术后各随访时间点邻椎的旋转角度均较术前明显增大（P＜0.05），末次随访时上、下邻椎相对旋转角度分别为8.8°±4.9°和5.9°±3.2°，上邻椎相对旋转角度大于下邻椎（P＜0.05），其中L2/3融合时，上、下邻椎（L1、L4）的相对旋转角度变化最明显。末次随访时11例患者出现邻近节段退变，退变组上邻椎相对旋转角度为10.6°±3.0°，非退变组为8.2°±2.8°，两组间有显著性差异（P＜0.05）；退变组与非退变组腰痛VAS评分分别为1.4±0.7分和1.2±0.8分，腿痛VAS评分分别为1.2±1.0分和1.3±0.7分，ODI分别为（10.3±8.2）%和（9.5±6.3）%，两组间无显著性差异（P＞0.05）；两组间椎间隙高度及ROM均无明显差异（P＞0.05）。结论：腰椎固定融合术后相邻节段动态相对旋转度增大，尤以上邻椎明显，与腰椎屈伸活动度及椎间隙高度相比，相邻节段旋转角度可能是预测邻近节段退变更敏感的指标。

英文摘要:

  【Abstract】 Objectives: To evaluate the effect of lumbar fusion for adjacent segments degeneration(ASD) by spinal moire system(DIERS Formetric 4D, Diers International GmbH, Schlangenbad, Germany) and radiological examination. Methods: The data of 73 patients who received single segmental lumbar fusion were collected in this study from January 2016 to June 2016. There were 40 male and 33 female cases with an average of 47.2±10.3(40-60) years old. The DIERS spinal moire system was applied to collect and calculate the relative rotation angle between fusion level and adjacent vertebrae during walk pre-operation at postoperative 6, 12 and 24 months respectively. X-ray examination was applied to evaluate the range of motion(ROM) and disc height(DH) of adjacent levels before and after operation. At the final follow-up, the low back and leg pain and lumbar function were evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). According to degeneration, the patients were divided into ASD group and non-ASD group and were compared and analyzed. Results: The relative rotation angle of upper and lower adjacent vertebrae was 5.2°±2.1° and 3.1°±2.1° before operation, while both angles increased obviously at each follow-up point(P＜0.05). Finally, the upper and lower angle was 8.8°±4.9° and 5.9°±3.2° respectively(P＜0.05). The most obvious changes were observed in the patients with L2-3 fusion. At the final follow-up, 11 patients suffered from ASD whose upper relative rotation angle was larger(P＜0.05). The relative rotation angle of the upper adjacent vertebrae in the degenerative group was 10.6±3.0, and that in the non-degenerative group was 8.2±2.8. The degenerative group was larger than that in the non-degenerative group(P<0.05). The VAS scores of low back pain in degenerative and non-degenerative groups were 1.4±0.7 and 1.2±0.8, leg pain were 1.2±1.0 and 1.3±0.7 and ODI were (10.3±8.2)% and (9.5±6.3)% respectively. The DH, ROM and clinical outcome showed no significant differencebetween the 2 groups(P＞0.05). Conclusions: The relative rotation angle, especially upper one, increases obviously after operation which maybe a more sensitive index to predict ASD compared to ROM and DH.