腰椎人工椎间盘置换术对腰椎矢状面影响的影像学研究

摘要

目的 探讨腰椎人工椎间盘置换术(ADR)对于腰椎矢状面序列的影响.方法 回顾性分析对2009年3月至2013年3月在首都医科大学附属北京朝阳医院脊柱外科因椎间盘退变性疾病行腰椎ADR的32例患者的影像学资料进行回顾性分析.32例患者中,男性18例,女性14例,手术时平均年龄为45.6岁(35 ～60岁);手术节段:L3～42例,L4～5 15例,L5/S15例,L3～4+ L4～53例,L4～5+ L5/S17例;随访时间15 ～ 63个月(平均32.0个月).测量术前、术后1个月及末次随访时患者腰椎前凸角(LL)、病变节段前凸角(SL)、骶骨倾斜角(SS).对术前、术后1个月及末次随访时各测量参数分别进行重复测量方差分析;以独立样本t检验分析术后1个月及末次随访时双节段组与单节段组LL的统计学差异;使用偏相关分别对术前、术后1个月及末次随访时各参数进行相关性分析.结果 术后1个月时LL较术前平均减少1.8°,但差异无统计学意义(P＞0.05),末次随访时LL较术后1个月平均增加6.8°(P＜0.05),较术前亦明显增加(P＜0.05);自术前至末次随访时SL呈递增趋势(P＜0.05);SS亦呈递增趋势,但术前、术后1个月及末次随访之间的差异均无统计学意义(P＞0.05).术后1个月、末次随访时双节段组与单节段组LL的差异均无统计学意义(P＞0.05).术前、术后1个月及末次随访LL与SL均无相关性(P＞0.05),LL与SS均呈正相关(P＜0.01).结论 腰椎ADR有助于维持、改善腰椎近中期矢状面序列.单、双节段ADR对LL的影响无显著性差异.LL始终与SS呈正相关,未发现LL与SL存在明显相关性.%Objective To investigate effect of Activ L total lumbar disc replacement on lumbar sagittal alignment.Methods The imaging data of patients with degenerative disc disease received Activ L total lumbar disc replacement at Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University from March 2009 to March 2013 were retrospectively analyzed.The average age was 45.6 years (range,35-60 years) and the surgery levels were as follows: L3-4 2 cases, L4-5 15 cases, L5/S1 5 cases, L3-4 + L4-5 3 cases,L4-5 + L5/S1 7 cases.All patients were followed up for 15 to 63 months(average,32 months).Radiographic parameters such as lumbar lordosis angle(LL), segment lordosis angle(SL) and sacral slope angle(SS) were recorded.All the radiographic parameters were compared using one-way ANOVA at different stage.Lumbar lordosis angle of the two-level was compared with the one of one-level by using independent sample t-test before and after the operation.A partial correction test was carried out to determine the corrections between the parameters preoperatively, one month after the operation and at final follow-up.Results One month after the operation, the lumbar lordosis angle decreased by an average of 1.8°, but there was no statistically significant (P ＞ 0.05).Compared with one month postoperation, the lumbar lordosis angle increased by an average of 6.8° (P ＜ 0.05), which also increased a lot compared with preoperation(P ＜0.05).The value of segment lordosis angle was rising up from preoperation to the final follow-up(P ＜ 0.05), so was the value of sacral slope angle, but there was no statistically significant between different stage (P ＞ 0.05).The lumbar lordosis angle showed no significant difference between double-level ones and single-level ones at different stage (P ＜ 0.05).The lumbar lordosis angle showed positive correlation with the sacral slope (P ＜ 0.001), however, the lumbar lordosis angle showed no corrected with the segment angle all the time (P ＞ 0.05).Conclusions The total lumbar disc replacement with Activ L prosthesis had contributed to maintain and improve the lumbar alignment in the short and medium term.Double-or single-level total lumbar disc replacement had no significant effect on the value of lumbar lordosis angle.The lumbar lordosis angle showed positive correlation with the sacral slope all the time with no correlation between lumbar lordosis angle and sacral slope.