腰椎单节段与双节段椎间融合对脊柱影响的临床研究

目的对腰椎单节段与双节段椎间融合内固定术对脊柱的影响进行临床比较研究.方法 2003年1月至2006年1月,对我院腰椎行单节段固定融合术的302例及双节段固定融合术的215例患者从临床症状(Oswestry评分)、体征(腰椎活动度)、影像学(X线、MRI)三方面进行回顾性临床评估,并将结果进行比较.结果随访时间1.5-6年,平均随访3.5年,单节段固定融合组在Oswestry评分、腰椎活动度方面均优于双节段固定融合组,但差异无统计学意义;87%以上的患者在术后1.5-2年均可获得椎间骨性融合;单节段固定融合组中有4例、双段固定融合组有2例在术后1年以上出现了邻近节段症状而再次手术治疗.结论单、双节段椎间融合内固定术均可获得理想的手术效果,术后对患者的生活影响不大,对脊柱的活动度影响无明显差异,但椎间融合内固定术后对术前存在退变的相邻节段影响较大,可根据患者意见及椎间盘退变程度决定是否同时行多节段的融合固定或弹性内固定术.

Clinical research of the effect of lumbar mono-segment and di-segment intervertebral implanted bone fusion on spine

Objective To compare the clinical effects of lumbar mono-segment and di-segment interverbral implanted bone fusion and internal fixation on spine. Methods From January 2003 to January 2006, we evaluated retrospectively the clinical symptoms （oswestry grade）; physical signs （range of lumbar motion） and imagelogy （X-ray and MRI） of 302 cases of lumbar mono-segment and 215 cases of di-segment interverbral implanted bone fusion and internal fixation and campared the results. Results The average followed up period was 3.5 years （range; 1.5-6 years）. The oswestry grade and range of lumbar motion of mono-segment fixation and internal fixataion group were all higher than that of di-segment fixation and internal fixataion group, but there was no statistical significance. Postoperatively, above 87% of all patients got interverbral bone fusion within1.5-2 years. There were 4 cases of mono-segment fixation and 2 cases of di-segment fixation were conducted other surgeries in at least 1 year postoperatively due to the symptoms of the adjacent segment. Conclusions The mono-segment and di-segment interverbral implanted bone fusion and internal fixation can both get ideal surgical effects. No obvious difference existing on the patients compared with their lives preoperatively. There is no difference to the spinal motion after comparing the two methods. However, interverbral implanted bone fusion and internal fixation affects obviously the adjacent degenerative segments existing preoperatively. Multi-segment bone fusion and internal fixation or elastic internal fixation should be considered simultaneously according to the patient＇s opinion and the degenerative condition of the interertebral disk.