PLIF术后融合节段Cobb角的大小与邻椎病的关系
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摘要
目的探讨腰椎后路减压内固定融合术(PLIF)术后病变节段Cobb角的改变与邻椎病的关系。方法回顾性分析我院2015年1月～2016年12月诊断为腰椎退行性病变且行PLIF的患者68例,病变节段累及L4～5,按PLIF术后病椎的融合角度是否>5°分为A组和B组各34例,比较两组记录两组患者手术时间、术中出血量、术后伤口引流量、手术后住院时间、术后JOA评分、术后矢状面病变节段融合的Cobb角及术后2年邻椎退变的发生率。结果 A组手术平均时间(126.06±17.38)min、平均术中出血量(254.38±94.72)ml、平均术后引流量(258.62±117.67)ml、平均术后住院时间(14.65±2.67)d、术后JOA评分(26.65±1.65)分,分别与B组[手术平均时间(130.82±18.22)min、平均术中出血量(264.65±84.59)ml、平均术后引流量(260.88±85.89)ml、平均术后住院时间(14.44±3.09)d,术后JOA评分(26.94±1.18)]比较,差异均无统计学意义(P>0.05)。PLIF术后A组邻椎退变发病人数为3例,发病率为8.82%,B组邻椎退变发病人数为10例,发病率为29.41%,两组比较A组邻椎退变率低于B组,差异具有统计学意义(P<0.05)。结论对于腰椎减压内固定融合术的患者,病变节段的融合角度过小可使患者相邻节段Cobb角更易于发生退变,术中应避免融合角度过小,从而降低邻椎病的发生率。
Objective To explore the relationship between the changes of Cobb Angle and adjacent vertebra disease after PLIF surgery.Methods Retrospective analysis of 68 patients who were explicitly diagnosed with lumbar degenerative disease and underwent lumbar posterior decompression,internal fixation and fusion(PLIF)in our hospital from January 2015 to December 2016,the lesion segment is L4-5,the fusion angle of postoperative disease vertebra is greater than 5 °or not is divided into group A and group B(n = 34),the degeneration of adjacent vertebrae was compared between the two groups.Result Group A: mean operative time(126.06 ±17.38) min,mean intraoperative blood loss(254.38 ±94.72) ml,mean postoperative drainage volume(258.62±117.67) ml,mean postoperative hospitalization time(14.65±2.67) d,postoperative JOA score(26.65±1.65),Group B: mean operative time(130.82±18.22) min,mean intraoperative blood loss(264.65±84.59) ml,mean postoperative drainage volume(260.88± 85.89) ml,mean postoperative hospitalization time(14.44±3.09) d,postoperative JOA score(26.94±1.18),there was no statistically significant difference between the two groups(P>0.05).3 cases of ASD occurred in group A after PLIF surgery,the incidence was 8.82%,the incidence in group B was 10 cases,the incidence was 29.41%,Compared between the two groups,the rate of vertebral degeneration in group B was significantly higher than that in group A(P<0.05),the difference was statistically significant.Conclusion For patients undergoing lumbar decompression and internal fixation fusion,the small fusion Angle of the lesion segment makes the Cobb Angle of the adjacent segment easier to change,intraoperative fusion Angle should be avoided too small,thereby reducing the incidence of the Adjacent vertebral disease.
Objective To explore the relationship between the changes of Cobb Angle and adjacent vertebra disease after PLIF surgery.Methods Retrospective analysis of 68 patients who were explicitly diagnosed with lumbar degenerative disease and underwent lumbar posterior decompression,internal fixation and fusion(PLIF)in our hospital from January 2015 to December 2016,the lesion segment is L4-5,the fusion angle of postoperative disease vertebra is greater than 5 °or not is divided into group A and group B(n = 34),the degeneration of adjacent vertebrae was compared between the two groups.Result Group A: mean operative time(126.06 ±17.38) min,mean intraoperative blood loss(254.38 ±94.72) ml,mean postoperative drainage volume(258.62±117.67) ml,mean postoperative hospitalization time(14.65±2.67) d,postoperative JOA score(26.65±1.65),Group B: mean operative time(130.82±18.22) min,mean intraoperative blood loss(264.65±84.59) ml,mean postoperative drainage volume(260.88± 85.89) ml,mean postoperative hospitalization time(14.44±3.09) d,postoperative JOA score(26.94±1.18),there was no statistically significant difference between the two groups(P>0.05).3 cases of ASD occurred in group A after PLIF surgery,the incidence was 8.82%,the incidence in group B was 10 cases,the incidence was 29.41%,Compared between the two groups,the rate of vertebral degeneration in group B was significantly higher than that in group A(P<0.05),the difference was statistically significant.Conclusion For patients undergoing lumbar decompression and internal fixation fusion,the small fusion Angle of the lesion segment makes the Cobb Angle of the adjacent segment easier to change,intraoperative fusion Angle should be avoided too small,thereby reducing the incidence of the Adjacent vertebral disease.
引文
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[2]李永新,尹利荣,李燕莉,等.融合结合非融合技术治疗腰椎退行性疾病的临床疗效分析[J].检验医学与临床,2017,14(11):1594-1596.
[3]李政,胡洪波,李玉民,等.单纯PLIF与PLIF联合椎间融合器治疗腰椎滑脱的疗效比较[J].中国骨与关节损伤杂志,2017,32(5):505-507.
[4]杨海青,段洪,闵捷,等.钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性[J].中国组织工程研究,2014,18(53):8590-8595.
[5]Shriver MF,Lubelski D,Sharma AM,et al.Adjacent segment degeneration and disease following cervical arthroplasty:a systematic review and meta-analysis[J].The Spine Journal,2016,16(2):168-181.
[6]Molinos M,Almeida CR,Caldeira J,et al.Inflammation in intervertebral disc degeneration and regeneration[J].J Royal Soc Interface,2015,12(104):20141191.
[7]罗斌,梅锦荣,王国荣,等.单纯PLIF与PLIF联合PLF治疗腰椎退行性疾病的临床效果对比研究[J].中国现代医生,2013,51(28):28-30,33.
[8]刘湘,赵晓东,龙耀武,等.腰椎间盘突出症严重程度与腰椎曲度相关性的影像学研究[J].广东医学,2017,38(24):3824-3826,3830.
[9]蒲兴魏,刘进南,王翀,等.腰椎间盘突出症患者腰骶部疼痛与腰椎曲度的相关性[J].广东医学,2013,34(1):80-82.
[10]李嘉欣,汪翔,何玉麟.腰椎曲度与腰椎间盘突出的影像学研究[J].实用骨科杂志,2016,22(11):1052-1054.