脊柱-骨盆矢状面形态变化与椎间盘摘除及后路椎体间植骨融合的关系
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摘要
背景:腰椎间盘摘除后患者复发风险较高,再次手术治疗的方式有多种,但目前对复发患者脊柱-骨盆矢状面形态的研究并不多。目的:对比研究椎间盘摘除与后路椎体间植骨融合对腰椎间盘突出复发患者的脊柱-骨盆矢状面形态的影响。方法:61例腰椎间盘突出椎间盘摘除后再发病例,按再次修复方式分为2组,椎间盘摘除组30例;后路椎体间植骨融合组31例。在站立位脊柱侧位X射线片上测量两组治疗前后椎间盘高度、腰椎前凸角、骨盆投射角,并对两组指标进行比较分析。结果与结论:摘除组治疗后椎间盘高度、腰椎前凸角及骨盆投射角未见明显变化(P>0.05);后路椎体间植骨融合组治疗后椎间盘高度、腰椎前凸角及骨盆投射角较治疗前明显增加(P<0.05);治疗前两组间椎间盘高度、腰椎前凸角、骨盆投射角未见明显差异(P>0.05);治疗后后路椎体间植骨融合组椎间盘高度、腰椎前凸角、骨盆投射角较摘除组明显增加(P<0.05)。结果证实,椎间盘摘除不能显著改变再次手术患者的脊柱-骨盆矢状面形态;后路椎体间植骨融合较椎间盘摘除对再次手术患者的脊柱-骨盆矢状面形态的影响更大。
BACKGROUND: The patients undergoing lumbar discectomy have a higher risk of recurrence. There are many different ways of reoperation, but there are few studies on spine-pelvis sagittal morphology of patients with recurrent lumbar disc herniation. OBJECTIVE: To compare the effect of discectomy and posterior lumbar interbody fusion on spine-pelvis sagittal morphology of patients with recurrent lumbar disc herniation. METHODS: Sixty-one patients of recurrent lumbar disc herniation after discectomy were divided into discectomy group(n=30) and posterior lumbar interbody fusion group(n=31) according to the re-repair method. The height of intervertebral disc, lumbar lordosis and pelvic projection angle in the two groups before and after treatment were measured and compared based on standing spine lateral X-ray images. RESULTS AND CONCLUSION: After treatment, the height of intervertebral disc, lumbar lordosis and pelvic projection angle of patients in discectomy group were not significantly changed compared with before treatment(P > 0.05). After treatment, the height of intervertebral disc, lumbar lordosis and pelvic projection angle of patients in posterior lumbar interbody fusion group were significantly increased compared with those before treatment(P < 0.05). Before treatment, there were no significant differences in the height of intervertebral disc, lumbar lordosis and pelvic projection angle between discectomy and posterior lumbar interbody fusion groups(P > 0.05).After treatment, the height of intervertebral disc, lumbar lordosis and pelvic pelvic projection angle were significantly increased in the posterior lumbar interbody fusion group compared with the discectomy group(P < 0.05). These results demonstrate that discectomy cannot significantly change the spine-pelvis sagittal morphology of patients subjected to re-operation, but compared with the discectomy treatment, posterior lumbar interbody fusion has a greater impact on spine-pelvis sagittal morphology of patients subjected to re-operation.
BACKGROUND: The patients undergoing lumbar discectomy have a higher risk of recurrence. There are many different ways of reoperation, but there are few studies on spine-pelvis sagittal morphology of patients with recurrent lumbar disc herniation. OBJECTIVE: To compare the effect of discectomy and posterior lumbar interbody fusion on spine-pelvis sagittal morphology of patients with recurrent lumbar disc herniation. METHODS: Sixty-one patients of recurrent lumbar disc herniation after discectomy were divided into discectomy group(n=30) and posterior lumbar interbody fusion group(n=31) according to the re-repair method. The height of intervertebral disc, lumbar lordosis and pelvic projection angle in the two groups before and after treatment were measured and compared based on standing spine lateral X-ray images. RESULTS AND CONCLUSION: After treatment, the height of intervertebral disc, lumbar lordosis and pelvic projection angle of patients in discectomy group were not significantly changed compared with before treatment(P > 0.05). After treatment, the height of intervertebral disc, lumbar lordosis and pelvic projection angle of patients in posterior lumbar interbody fusion group were significantly increased compared with those before treatment(P < 0.05). Before treatment, there were no significant differences in the height of intervertebral disc, lumbar lordosis and pelvic projection angle between discectomy and posterior lumbar interbody fusion groups(P > 0.05).After treatment, the height of intervertebral disc, lumbar lordosis and pelvic pelvic projection angle were significantly increased in the posterior lumbar interbody fusion group compared with the discectomy group(P < 0.05). These results demonstrate that discectomy cannot significantly change the spine-pelvis sagittal morphology of patients subjected to re-operation, but compared with the discectomy treatment, posterior lumbar interbody fusion has a greater impact on spine-pelvis sagittal morphology of patients subjected to re-operation.
引文
[1]Yorimitsu E,Chiba K,Toyama Y,et al.Long term outcomes of standard discectomy for lumbar disc herniation.Spine.2001;26(6):652-657.
[2]Kim MS,Park KW.Hwang C,et al.Recurrence Rate of Lure-bar discherniation after open diseectomy in active young men.Spine.2009;34(1):24-29.
[3]侯登国,刘晓光,刘忠军.腰椎间盘突出症再手术原因分析和手术方式探讨[J].中国脊柱脊髓杂志,2007,17(5):357-360.
[4]赵福江,陈伸强,李危石,等.腰椎间盘突出症术后腰椎再手术的疗效及其影响因素分析[J].中国脊柱脊髓杂志,2012,22(7):594-599.
[5]Suk KS,Lee HM,Moon SH,et al.Recurrent Iumbar disc hemi-ation:results of operative management.Spine.2001;26(6):672-676.
[6]李宏,李淳德,邑晓东,等.腰椎间盘切除术后远期复发再手术的临床特点与治疗效果观察[J].中国脊柱脊髓杂志,2010,20(12):1018-1022.
[7]Park SJ,Lee CS,Chung SS,et al.Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis.Neurosurgery.2011;68(2 Suppl Operative):355-363;discussion 362-353.
[8]Sevrain A,Aubin C-E,Gharbi H,et al.Biomechanical evaluation of predictive parameters of progression in adolescent isthmic spondylolisthesis:a computer modeling and simulation study.Scoliosis.2012;7(1):2.
[9]Swartz KR,Trost GR.Recurrent lumbar disc herniation.Neu-rosurg Focus.2003;15(3):E10.
[10]Atlas SJ,Keller RB,Chang Y.et al.Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation:five-year outcomes from the Maine Lumbar Spine Study.Spine.2001;26(10):1179-1187.
[11]杨曦,宋跃明.脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响[J].中国脊柱脊髓杂志,2013,23(10):935-938.
[12]孙卓然,李危石.骨盆矢状位形态参数在脊柱外科的应用[J].中华外科杂志,2012,50(12):1147-1150
[13]Mac-Thiong JM,Labelle H,Berthonnaud E,et al.Sagittal spinopelvic balance in normal children and adolescents.Eur Spine J.2007;16:227-234.
[14]Marty C,Boisaubert B,Descamps H,et al.The sagittal anatomy of the sacrum among young adults,infants,and spondylnlisthesis patients.Eur Spine J.2002;11:119-125.
[15]Roussouly P,Pinheiro-Franco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology.Eur Spine J.2011;20(Suppl 5):S609-s618.
[16]Mobbs RJ,Neweombe RL,Chandran KN.Lumbar discectomy and the diabetic patient:incidence andoutcome.J Clin Neurosci.2001;8(1):10-13.
[17]Chen Z,Zhao J,Liu AG,et al.Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion.International Orthopaedics(SICOT),2009;33(1):197-201.
[18]Wong CB,Chen WJ,Chen LK,et al.Clinical outcomes of revision lumbar spinal surgery:124 patients with a minimum of two years of follow-up.Chang Gung Med J.2002;25(3):175-182.
[19]Brantigan JW,Neidre A.Achievement of normal sagittal plane alignment using a wedged carbon fiber reinforced polymer fusion cage in treatment of spondylolisthesis.Spine.2003;3(3):186-196.
[20]Shin MH,Ryu KS,Hur JW,et al.Comparative study of lumbopelvic sagittal alignment between patients with and without sacroiliac joint pain after lumbar interbody fusion.Spine.2013;38(21):E1334-1341
[21]郭金明,阿里木江.成年人下腰痛与腰椎前凸和骶骨倾斜角的关系[J].实用骨科杂志,2007,13(10):577-579.
[22]Liu H,LI S,Wanq T,et al.An analysis of spinopelvic sagittal alignment after lumbar lordosis reconstruction for degenerative spinal diseases:how much balance can be obtained?.Spine.2014;39(26):B52-59.
[23]Golbakhsh MR,Hamidi MA,Hassanmirzaei B.Pelvic incidence and lumbar spine instability correlations in patients with chronic low backpain.Asian J Spots Med.2012;3:291-296.
[24]蔡思逸,花苏榕,李书纲.骨盆参数及骨盆空间位置关系与腰椎稳定性的相关性[J].中华医学杂志,2014,94(17):1338-1341.
[25]江龙,朱泽章,邱勇,等.青少年腰椎间盘突出症患者脊柱一骨盆矢状面形态的影像学研究[J].中国脊柱脊髓杂志,2013,23(2):140-144.
[26]Hikata T,Kamata M,Furukawa M.Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease.J Spinal Disord Tech.2014;27(2):70-75.
[27]Kepler CK,Rihn JA,Radcliff KE,et al.Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion.Orthop Surg.2012;4(1):15-20.
[28]Lim JK,Kim SM.Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis.J Korean Neurosurg Soc.2014;55(6):331-336.
[29]Okuda S,Oda T,Yamasaki R,et al.Repeated adjacent-segment degeneration after posterior lumbar interbody fusion.J Neurosurg Spine.2014;20(5):538-541.
[2]Kim MS,Park KW.Hwang C,et al.Recurrence Rate of Lure-bar discherniation after open diseectomy in active young men.Spine.2009;34(1):24-29.
[3]侯登国,刘晓光,刘忠军.腰椎间盘突出症再手术原因分析和手术方式探讨[J].中国脊柱脊髓杂志,2007,17(5):357-360.
[4]赵福江,陈伸强,李危石,等.腰椎间盘突出症术后腰椎再手术的疗效及其影响因素分析[J].中国脊柱脊髓杂志,2012,22(7):594-599.
[5]Suk KS,Lee HM,Moon SH,et al.Recurrent Iumbar disc hemi-ation:results of operative management.Spine.2001;26(6):672-676.
[6]李宏,李淳德,邑晓东,等.腰椎间盘切除术后远期复发再手术的临床特点与治疗效果观察[J].中国脊柱脊髓杂志,2010,20(12):1018-1022.
[7]Park SJ,Lee CS,Chung SS,et al.Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis.Neurosurgery.2011;68(2 Suppl Operative):355-363;discussion 362-353.
[8]Sevrain A,Aubin C-E,Gharbi H,et al.Biomechanical evaluation of predictive parameters of progression in adolescent isthmic spondylolisthesis:a computer modeling and simulation study.Scoliosis.2012;7(1):2.
[9]Swartz KR,Trost GR.Recurrent lumbar disc herniation.Neu-rosurg Focus.2003;15(3):E10.
[10]Atlas SJ,Keller RB,Chang Y.et al.Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation:five-year outcomes from the Maine Lumbar Spine Study.Spine.2001;26(10):1179-1187.
[11]杨曦,宋跃明.脊柱-骨盆矢状位曲度对腰椎退变性疾病的影响[J].中国脊柱脊髓杂志,2013,23(10):935-938.
[12]孙卓然,李危石.骨盆矢状位形态参数在脊柱外科的应用[J].中华外科杂志,2012,50(12):1147-1150
[13]Mac-Thiong JM,Labelle H,Berthonnaud E,et al.Sagittal spinopelvic balance in normal children and adolescents.Eur Spine J.2007;16:227-234.
[14]Marty C,Boisaubert B,Descamps H,et al.The sagittal anatomy of the sacrum among young adults,infants,and spondylnlisthesis patients.Eur Spine J.2002;11:119-125.
[15]Roussouly P,Pinheiro-Franco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology.Eur Spine J.2011;20(Suppl 5):S609-s618.
[16]Mobbs RJ,Neweombe RL,Chandran KN.Lumbar discectomy and the diabetic patient:incidence andoutcome.J Clin Neurosci.2001;8(1):10-13.
[17]Chen Z,Zhao J,Liu AG,et al.Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion.International Orthopaedics(SICOT),2009;33(1):197-201.
[18]Wong CB,Chen WJ,Chen LK,et al.Clinical outcomes of revision lumbar spinal surgery:124 patients with a minimum of two years of follow-up.Chang Gung Med J.2002;25(3):175-182.
[19]Brantigan JW,Neidre A.Achievement of normal sagittal plane alignment using a wedged carbon fiber reinforced polymer fusion cage in treatment of spondylolisthesis.Spine.2003;3(3):186-196.
[20]Shin MH,Ryu KS,Hur JW,et al.Comparative study of lumbopelvic sagittal alignment between patients with and without sacroiliac joint pain after lumbar interbody fusion.Spine.2013;38(21):E1334-1341
[21]郭金明,阿里木江.成年人下腰痛与腰椎前凸和骶骨倾斜角的关系[J].实用骨科杂志,2007,13(10):577-579.
[22]Liu H,LI S,Wanq T,et al.An analysis of spinopelvic sagittal alignment after lumbar lordosis reconstruction for degenerative spinal diseases:how much balance can be obtained?.Spine.2014;39(26):B52-59.
[23]Golbakhsh MR,Hamidi MA,Hassanmirzaei B.Pelvic incidence and lumbar spine instability correlations in patients with chronic low backpain.Asian J Spots Med.2012;3:291-296.
[24]蔡思逸,花苏榕,李书纲.骨盆参数及骨盆空间位置关系与腰椎稳定性的相关性[J].中华医学杂志,2014,94(17):1338-1341.
[25]江龙,朱泽章,邱勇,等.青少年腰椎间盘突出症患者脊柱一骨盆矢状面形态的影像学研究[J].中国脊柱脊髓杂志,2013,23(2):140-144.
[26]Hikata T,Kamata M,Furukawa M.Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease.J Spinal Disord Tech.2014;27(2):70-75.
[27]Kepler CK,Rihn JA,Radcliff KE,et al.Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion.Orthop Surg.2012;4(1):15-20.
[28]Lim JK,Kim SM.Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis.J Korean Neurosurg Soc.2014;55(6):331-336.
[29]Okuda S,Oda T,Yamasaki R,et al.Repeated adjacent-segment degeneration after posterior lumbar interbody fusion.J Neurosurg Spine.2014;20(5):538-541.