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

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。中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Relationship between spine-pelvis sagittal morphological changes,discectomy and posterior lumbar interbody fusion

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.