摘要
目的:探讨腰椎融合术后症状性邻近节段退变的临床特点和再手术的治疗效果。方法:选取2007年5月至2012年4月在北京大学第一医院骨科收治的因腰椎融合术后症状性邻近节段退变再手术的病例28例,平均年龄(64.3±8.7)岁,再次手术距初次融合术时间平均(47.5±30.8)个月。症状性邻近节段退变发生在头侧邻近节段12例、尾侧邻近节段14例、双侧邻近节段2例;表现为邻近节段腰椎管狭窄12例、腰椎间盘突出13例、腰椎间盘突出合并腰椎管狭窄3例,这其中伴有邻近节段腰椎不稳定病例11例。19例病例症状、体征与影像学定位诊断相符合,9例病例定位诊断不完全相符再手术前进行诊断性神经根阻滞术。依据翻修方法将病例分为两组,邻近节段未固定融合组8例,邻近节段固定融合组20例。应用腰痛视觉模拟评分(visual analog score,VAS)、下肢痛VAS评分、腰椎日本骨科协会(Japanese Orthopedic Association,JOA)评分(29分法)评定临床症状改善情况;采用Prolo腰椎功能评分评定患者术后功能改善情况,再手术前、末次随访各评价一次。结果:邻近节段未固定融合组的平均手术时间(86.3±17.1)min,平均出血量(125.0±37.8)mL,术中硬膜囊损伤致术后脑脊液漏1例;邻近节段固定融合组的平均手术时间(201.6±71.0)min,平均出血量(313.6±218.9)mL,术中硬膜囊损伤致术后脑脊液漏4例。再手术后平均随访25.5个月,临床症状改善方面邻近节段未固定融合组末次随访腰痛VAS评分、下肢痛VAS评分、腰椎JOA评分和Prolo功能评分分别为2.4±1.2、2.8±1.4、23.5±4.2、8.2±1.5,较术前5.5±2.9、6.8±2.5、13.7±5.2、4.3±2.1改善差异有统计学意义(P均<0.001);邻近节段固定融合组末次随访腰痛VAS评分、下肢痛VAS评分、腰椎JOA评分和Prolo功能评分分别为3.3±1.9、3.1±1.2、22.2±4.4、7.7±1.6,较术前5.4±2.7、7.0±2.4、13.0±5.6、3.9±1.9改善差异有统计学意义(P均<0.001);两组间比较末次随访腰痛VAS评分邻近节段未固定融合组低于邻近节段固定融合组,差异有统计学意义(P=0.028),术前各项评分及末次随访下肢痛VAS评分、腰椎JOA评分和Prolo功能评分两组间差异无统计学意义。结论:腰椎融合术后症状性邻近节段退变的诊断和治疗比较困难,选择合适的再手术术式可以获得较好的临床效果。
Objective：To evaluate the clinical characteristics and reoperation of symptomatic adjacent segment degeneration post-operation of lumbar fusion.Methods：In the study,28 cases of symptomatic adjacent segment degeneration post-operation of lumbar fusion from May 2007 to April 2012 were retrospectively reviewed,with an average age of（64.3±8.7） years.The mean period between reoperation and primary fusion surgery was（47.5±30.8） months.Symptomatic adjacent segment degeneration located in cephalic segments in 12 cases,in caudal segments in 14 cases and in both segments in 2 cases.Of all the 28 patients,12 suffered from lumbar stenosis,other 13 from lumbar disc herniation and still other 3 from both lumbar stenosis and disc herniation,of whom 11 were together with segment instability.Localization diagnoses of 19 cases were clear and other 9 received diagnostic nerve root block.The cases were divided into two groups by the type of reoperation,of which 8 cases were in adjacent degenerative segment nonfusion group and the other 20 cases in adjacent degenerative segment fusion group.The clinical results were assessed by lumbar pain visual analog score（VAS） and lower limber pain VAS,lumbar Japanese Orthopedic Association（JOA） score and Prolo functional score before operation and in the final follow-up.Results：In adjacent degenerative segment nonfusion group,the average operation time was（86.3±17.1） min and average blood volume was（125.0±37.8） mL of reoperation and 1 case with dural injury;and in adjacent degenerative segment fusion group,the average operation time was（201.6 ±71.0） min and average blood volume was（313.6±218.9） mL of revision surgery and 4 cases with dural injury.The average follow-up period was 25.5 months.In the final follow-up,lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 2.4±1.2,2.8±1.4,23.5±4.2 and 8.2±1.5,which were better than pre-operation 5.5±2.9,6.8±2.5,13.7±5.2 and 4.3±2.1,P 0.001;lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 3.3±1.9,3.1±1.2,22.2±4.4 and 7.7±1.6,which were better than pre-operation 5.4±2.7,7.0±2.4,13.0±5.6 and 3.9±1.9,P 0.001.In the final follow up,lumbar pain VAS of adjacent degenerative segment nonfusion group was better than that adjacent degenerative segment fusion group（P=0.028）.Conclusion：Symptomatic adjacent segment degeneration post-operation of lumbar fusion is difficult for diagnosis and treatment.Appropriate reoperation could get the good results.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第6期855-859,共5页
Journal of Peking University:Health Sciences
关键词
脊柱融合术
腰椎
再手术
Spinal fusion
Lumbar vertebrae
Reoperation
