腰椎融合内固定对邻近节段退变的影响

背景：随着脊柱手术方法的成熟及内固定器械的发展，脊柱内固定融合术已成为许多脊柱疾患的主要治疗方法，但远期出现的邻近节段退变的问题也越来越突出。目的：回顾分析脊柱内固定后邻近节段发生退变的相关因素，有助于改善脊柱内固定的方法，减少远期并发症。方法：分别应用计算机检索维普、Pubmed数据库2005年1月至2012年12月关于脊柱融合内固定后邻近节段退行性变的文章，检索词分别设定为“脊柱融合内固定、邻近节段退变、单侧cage椎间融合固定”和“Adjacent segment degeneration、spine fusion、unilateral single cage”。筛选资料，选取脊柱融合后邻近节段退变的文献，筛除非随机试验的研究，将随机对照试验作为纳入标准，排除重复性研究文献。主要从术式、融合方式及邻近节段破坏等方面讨论脊柱融合后邻近节段退变的影响因素。结果与结论：筛选得到27篇符合纳入标准文献，从中得出融合节段数目、方式、部位及手术时对邻近节段小关节破坏是引起邻近节段退变的主要影响因素。人工椎间盘置换、单侧cage椎间隙植骨内固定在预防、延缓邻近节段退变上有一定作用。在决定融合固定术前，应综合考虑内固定材料、手术方式可能带来的影响，避免或降低邻近节段退变的发生。

Effect of lumbar fusion and fixation on adjacent segment degeneration

BACKGROUND： With the mature of the spinal surgery and the development of fixation instrument, spine fusion and fixation has become the main method for the treatment of spine diseases, but the long-term adjacent segment degeneration is more and more serious. OBJECTIVE： To retrospectively analyze the risk factors of adjacent segment degeneration after spinal fixation which can help to improve spine fixation and reduce the long-term complications. METHODS： A computer-based search was performed on VIP database and PubMed database for the articles on the adjacent segment degeneration after spine fusion and fixation published from January 2005 to December 2012, the key words were ＂spine fusion, adjacent segment degeneration, unilateral single cage＂ in Chinese and English. All articles were selected firstly, and those related to adjacent segment degeneration after spine fusion were collected. Randomized controlled trials were included and the nonrandomized controlled trials were excluded. The duplicated investigations were eliminated. The articles explored the adjacent segment degeneration after spine fusion mainly dependent on the surgical method, fusion mode and damage of adjacent segment. RESULTS AND CONCLUSION： A total of 27 articles were coincident with the inclusion criteria. From the articles, we find that the fusion number, way, position and the damage to the adjacent segment were the main reasons for adjacent segment degeneration. The total disc replacement and unilateral single cage play important role in preventing and delaying the adjacent segment degeneration. The influence of the fixation materials and surgical way should be considered before fusion, in order to avoid and reduce the occurrence of adjacent segment degeneration.