颈椎前路融合术后相邻节段退变的临床观察与分析

目的]研究颈椎前路融合术是否必然导致邻近节段退变(adjacent segment degeneration,ASD).方法]1986～1999年,共346例采用“环锯法前路扩大脊髓减压+椎体间植骨内固定术”治疗颈椎退变性疾病,其中,1个间隙55例,2个间隙223例,3个间隙68例.分别评定融合节段头、尾侧相邻间隙及间隔间隙的影像学表现,对结果分组进行统计学检验.结果]术后随访13.5 (4.1 ～18)年,发生邻近节段明显退变的156例(45.1％),间隔节段明显退变的23例(6.6％).间隔节段退变明显少于邻近节段退变,两者比较差异有统计学意义(P＜0.05).单纯头侧邻近节段发生ASD 84例,单纯尾侧邻近节段发生ASD 27例,头、尾侧邻近节段均发生的45例.头侧邻近节段ASD发生率明显高于尾侧邻近节段,两者比较差异有统计学意义(P＜0.05).按照融合间隙数不同分为单间隙组、2间隙组和3间隙组,单间隙术后ASD 25例(45.5％),其中8例(14.5％)需2次手术.2间隙术后ASD 101例(45.3％),其中37例(16.6％)需2次手术.3间隙术后ASD 30例(44.1％),其中12例(17.6％)需2次手术.各组间ASD发生率比较无显著性差异(P＞0.05).结论]颈椎前路融合术加速了ASD的发生,并且多见于头侧相邻节段.单节段或多节段融合术后ASD的发生率无显著性差异.

Clinical observation and analysis of adjacent segment degeneration after anterior cervical fusion

Objective]To study whether the anterior cervical fusion inevitably lead to the adjacent segment degeneration(ASD). Methods]From 1986.1 to 1999.12,a total of 346 patients with cervical degenerative disease underwent the surgery of enlarged decompression with circular saw and auto iliac bone grafting.Among them there were 1 segment in 55 patients,2 segments in 223 patients and 3 segments in 68 patients.The two motion segments adjacent to the fused segment and interval from the fused segment were evaluated respectively for imaging changes and divided the results into groups for statistical test. Results]The patients were followed up for 13.5(4.1~18) years on average.Total 156 cases(45.1%) had obvious adjacent segment degeneration,23 cases(6.6%) had obvious interval segment degeneration.The interval segment degeneration was less than that of adjacent segment degeneration,and the comparative differences had statistically significance(P< 0.05).Cephalic adjacent segment resulted in ASD 84 cases,tail side adjacent segment resulted in ASD 27 cases,the two sides of cephalic and tail adjacent segment result ASD in 45 cases.The morbidity of cephalic adjacent segment ASD was higher than the tail side adjacent segment,and the comparative differences had statistically significance(P< 0.05).According to different fusions,the cases were divided into the single segments group,2 segments group and 3 segments group.The single segments group postoperative ASD: 25 cases(45.5%),and 8 cases(14.5%) needed the second operation.Two segments group postoperative ASD: 101 patients(45.3%),and 37 patients(16.6%) needed the second operation.Three segments group postoperative ASD: 30 patients(44.1%),and 12 cases(17.6%) needed the second operation.The incidence of ASD in each group had non-significance difference(P﹥0.05). Conclusion]The anterior cervical fusion accelerated the occurrence of ASD.The incidence of cephalic adjacent segment ASD was higher than that of tail side adjacent segments.The incidences of postoperative ASD in single segment and several segment fusion have no significant differences.