后路L4/5单节段融合术后椎间高度指数恢复情况对影像学邻近节段退变的影响

Effect of intervertebral height index recovery on radiographic degeneration of adjacent segments after posterior L4/5 single-level fusion

中文关键词:  椎间高度指数  影像学相邻节段退变  单节段  经椎间孔腰椎体间融合

英文关键词:Intervertebral height index  Radiographic adjacent segment degeneration  Single segment  Transforaminal lumbar interbody fusion

中文摘要:

  【摘要】 目的：探讨后路L4/5单节段融合术后椎间高度指数恢复情况对影像学邻近节段退变（radiographic adjacent segment degeneration，rASD）的影响。方法：收集我院自2008 年3月~2014年3月行L4/5节段经椎间孔腰椎体间融合（transforaminal lumbar interbody fusion，TLIF）手术病例354例，依据纳入和排除标准，共58例入组，将其按年龄分为青年组（20～40岁，16例，A组）和中年组（41~60岁，42例，B组）。记录术前及末次随访时的视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、腰椎日本骨科学会（Japanese Orthopaedic Association，JOA）评分评估临床疗效。测量术前、术后及末次随访时的L4/5椎间高度指数（intervertebral height index，IHI）、脊柱-骨盆参数[腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）和骨盆倾斜角（pelvic tilt，PT）]，分析rASD的发生率及其危险因素，并行Logistic回归分析。根据术中是否将IHI恢复至正常值范围，进一步将病例分为IHI恢复组（青年组与中年组分别为A1、B1组）和未恢复组（青年组与中年组分别为A2、B2组），比较各组rASD的发生情况。结果：术后平均随访59.36个月，两组患者术后临床疗效指标（VAS、ODI及JOA）均显著改善（P＜0.01）。末次随访时发生rASD者23例（39.7%）。A1组无rASD发生（0/6），A2组共发生rASD发生1例（1/10，10%）；B1组发生5例（5/16，31.25%），B2组发生17例（17/26，65.4%），两组间发生率具有统计学差异（P=0.031）。rASD发生的危险因素为年龄、随访时间、术后L4/5的IHI及术后LL，Logistic回归分析发现术后L4/5的IHI是显著的危险因素（OR=17.1，P＜0.001）。结论：后路L4/5单节段融合术后，对于41~60岁的患者，术中将IHI恢复至正常值参考范围，可以减少rASD的发生。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of recovered intervertebral height index on radiographic adjacent segment degeneration(rASD) during posterior L4/5 single-level fusion. Methods: A total of 354 patients who underwent L4/5 transforaminal lumbar interbody fusion(TLIF) surgery in our hospital from March 2008 to March 2014 were collected. According to the inclusion and exclusion criteria, a total of 58 patients were enrolled, and they were divided into youth group(20-40 years old, 16 cases, group A) and middle-aged group(41-60 years old, 42 cases, group B) according to age. Visual analogue scale(VAS) score, Oswestry disability index(ODI), and lumbar Japanese Orthopaedic Association(JOA) score were recorded before surgery and at final follow-up. L4/5 intervertebral height index(IHI) and spine-pelvis parameters[lumbar lordosis(LL), pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT)] were measured before and after surgery and at final follow-up, and the incidence and risk factors of rASD were analyzed, Logistic regression analysis was performed. According to whether the intervertebral height index was restored to the normal range during operation, patients were further divided into the intervertebral height index recovery group(youth group and middle-aged group were A1 and B1, respectively) and the non-recovery group(youth group and middle-aged group were A2 and B2, respectively), the incidence of rASD in each group was compared. Results: The mean postoperative follow-up was 59.36 months, and the postoperative clinical efficacy(VAS, ODI and JOA) was significantly improved in both groups(P<0.01). rASD occurred in 23 patients(39.7%) at final follow-up. No rASD occurred in A1 group(0/6), and 1 case(1/10, 10%) occurred in A2 group. There were 5 cases(5/16, 31.25%) in B1 group and 17 cases(17/26, 65.4%) in B2 group, with a statistically significant difference in incidence between the two groups(P=0.031). The risk factors for rASD were age, follow-up time, postoperative L4/5 IHI and postoperative LL, Logistic regression analysis showed that postoperative L4/5 IHI was a significant risk factor(OR=17.1, P<0.001). Conclusions: In patients aged 40-60 years, intraoperative restoration of the IHI to the normal reference range after posterior L4/5 single-level fusion may reduce the incidence of rASD.