单节段与多节段腰椎融合术后邻近节段退变的临床观察

摘要

目的：探讨单节段与多节段腰椎融合术后邻近节段退变的临床观察。方法：选取2007年5月～2011年8月在我科诊疗并接受腰椎融合术的61例病例，根据手术方式不同，主要分为单节段组和多节段组。通过测量椎间隙高度JOA评分、Prolo功能评分以及Pfirrmann评分系统，对患者术前、术后以及2年后随访的情况进行评分。结果：两组术后JOA评分、Prolo功能评分明显优于术前，但在末次随访评分中，多节段组明显高于单节段组（P＜0．05）；末次随访多节段组患者上、下邻近节段的Pfirrmann评分均明显高于单节段组，而椎间隙高度则明显小于单节段组（P＜0．05）。结论：腰椎融合术治疗效果显著，多节段融合术后邻近节段较单节段融合术更易发生退变，选择合适的手术方式可提升治疗效果，改善患者生活质量。%Objective:To observe the incidence of adjacent segment degeneration after single or multi-segmental lumbar fusion surgery .Methods:Sixty-one patients undergone lumbar fusion for degenerative disease between May 2007 and August 2011 in our department were allocated to treatment group with single-level arthrodesis or multi-segment fusion on the treatment policy basis .The impacts on the incidence of adjacent segment degeneration were evaluated by comparing the total scores with the two groups concerning the height of intervertebral space measured ,Japanese Orthopaedic Association(JOA) scoring, Prolo functional scale and Pfirrmann score before and after surgery as well as conditions in two years of follow-up.Results:The postoperative scores for JOA and Prolo function were significantly better than those before surgery ,yet the scores by the final follow-up were better in group with multiple segment fusion than those treated with single-level arthrodesis(P<0.05).In addition,final follow-up of patients with multiple segment interventions showed higher scores by Pfirrmann scoring assessment of the adjacent segments and better improved intervertebral space as compared with those treated with single segment fu -sion(P<0.05).Conclusion:Lumbar fusion intervention can significantly improve the adjacent level degeneration,yet multi-level fusion may predispose to incidence of adjacent segment degeneration than the single-level arthrodesis.Thus,appropriate treatment policy is important for successful outcomes and improvement of the life quality of patients with such entity .