摘要
目的通过中长期随访(5~15年),利用X线与MRI评估脊柱侧凸术后远端临近未融合节段椎间盘是否会发生退行性改变.方法回顾性分析25例接受脊柱后路矫形内固定植骨融合术且获得平均7.2年随访的脊柱侧凸患者病例资料.脊柱冠、矢状面形态改变的评估指标包括:胸椎侧凸角,腰椎侧凸角,脊柱整体冠状面平衡,胸椎后凸角,腰椎前凸角,脊柱整体矢状面平衡.根据下端固定椎的位置,合计远端未融合椎间盘节段数目.椎间盘退行性改变的评估指标包括:椎间盘高度,椎间盘钙化程度,终板形态是否规则,有无骨赘形成,是否存在许莫氏结节以及MRI?T2像上椎间盘信号的改变等并采用Pfirrmann评分系统对椎间盘的退变程度进行分级.所有以上评估椎间盘退变的指标均在术前与末次随访两个时间点进行对比观察.结果术后脊柱冠状面畸形得到明显矫正:胸椎侧凸Cobb角由术前53.3°矫正至21.8°,腰椎侧凸Cobb角由术前35.9°矫正至13.2°.矢状面胸椎后凸角由术前16.8°改善至术后23.5°(P<0.001),腰椎前凸角无明显丢失,以上术后参数在末次随访时均无显著丢失.脊柱的整体冠、矢状面平衡在三次测量中均在正常范围内且未发生明显变化.根据下端融合椎位置,共有88个远端未融合椎间盘节段被纳入到本次研究.随访时平均椎间高度较术前相比无明显丢失,其中椎间盘高度丢失在10%~20%有8个节段(9.1%),仅有1个节段(1.1%)椎间盘高度丢失>20%(高度丢失24.4%),所有节段椎间盘均未见椎间盘钙化、终板骨赘形成、终板硬化等退变性改变.随访时椎间盘Pfirrmann评分等级增加的共有9个节段(10.2%),其中L4-5节段4个(4.5%),L5-S1节段5个(5.7%).其余椎间盘在两次分级中未见明显变化.结论从总体上来看,在脊柱冠状面畸形得到明显矫正,矢状面形态维持良好的状态下,脊柱侧凸后路矫形内固定术在长期随访过程中尚未明显加重远端临近椎间盘的退变.
Objective To observe the degenerative changes below fused lumbar segments in adult patients and to evaluate degenerative changes of lower unfused lumbar disc with follow-up in surgically treated young patients with scoliosis.Methods 25 patients were retrospectively investigated in this longitudinal study with a follow-up of on average 7.2 years after surgery.Radiographic evaluation including the measurement of coronal,sagittal curve parameters and the assessment of spinal balance.Parameters including disc height,osteophytes and calcifications that correlated with disc degeneration were assessed from lateral radiographs.Each Radiographic measure was based off changes from preoperative to follow-up visit.Magnetic resonance imaging evaluation was done for preoperative and final follow-up lumbar discs,according to the classification of Pfirrmann.Results In the coronal plane,the thoracic curve(53.3°to 21.8°)and lumbar curve(35.9°to 13.2°)were significantly corrected postoperatively.In the sagittal plane,the thoracic kyphosis was significantly improved from 16.8°preoperatively to 23.5°postoperatively(P<0.001).Lumbar lordosis was similar before surgery and after surgery.Results obtained at the final follow-up indicated no significant loss of correction.No significant change in global sagittal and coronal balance was observed from preoperative to the latest follow-up.A total of 88 unfused levels were assessed based on lowest instrumented vertebra(LIV).Overall,no significant decrease in disc height was observed during follow-up.Only 1 level(1.1%)showed height loss>20%,8 levels(9.1%)showed 10%—20%height loss,the rest of levels show no significant change.No patient showed the incidence of osteophytes or calcifications.9 levels(10.2%)showed a significant worsening in Pfirrmann grading at the final follow-up,and the L4/L5(4 levels,4.5%)and L5/S1(5 levels,5.7%)disc were involved most likely.Conclusion Generally,spinal fusion and instrumentation in young patients with scoliosis did not lead to disc degeneration during 7.2 years followup.This may attribute to the greater correction of coronal thoracic and lumbar curve and the better maintenance of sagittal alignment.The incidence of L4/L5 and L5/S1 disc degeneration in few patients may as a result of nature history of disc degeneration.
出处
《浙江临床医学》
2019年第10期1306-1309,共4页
Zhejiang Clinical Medical Journal
基金
国家自然基金面上项目(81171767)
浙江省湖州市科技局公益性项目(2016GYB10)。
关键词
脊柱侧凸
融合
内固定
椎间盘退变
Scoliosis
Spinal fusion
Instrumentation
Disc degeneration
