短节段融合对退变性腰椎侧凸邻近节段椎间角的影响

目的 研究退变性腰椎侧凸短节段融合后邻近节段椎间角的变化特点.方法 回顾性分析2001年1月至2007年5月28例退变性腰椎侧凸患者的临床资料.其中男性6例,女性22例;平均年龄62岁;侧凸范围3～6个椎节,平均4.8个椎节.采用后方椎板切除减压、椎弓根螺钉内固定、后外侧植骨融合术;融合范围限制在侧凸范围内,平均融合3.3个椎节.术前、术后即刻及随访时拍摄站立腰椎正侧位X线片,测量冠状面侧凸Cobb角、近端融合椎上方邻近节段正位及侧位椎间角,并观察植骨融合及并发症发生情况.结果 患者均获随访,随访时间25～97个月,平均50个月.术后即刻侧凸Cobb角平均矫形率33.7%,末次随访时矫形丢失平均3.7°,术前及末次随访侧凸Cobb角与术后即刻比较差异均有统计学意义(P<0.05).末次随访时正位椎间角与术前、术后即刻相比差异均有统计学意义(P<0.05).末次随访时均未发现明显假关节形成及内植物相关并发症.结论 退变性腰椎侧凸短节段融合后对近端融合椎上方邻近节段正位椎间角的矫正有限,且不能阻止其进一步加重.

Radiological evaluation of intervertebral angles on short-segment fusion of degenerative lumbar scoliosis

Objective To analyze the radiological change of intervertebral angles after the shortsegment fusion of degenerative lumbar scoliosis.Methods From January 2001 to May 2007,28 patients (mean age 62 years old)with degenerative lumbar scoliosis,including 6 male and 22 female,were reviewed retrospectively.The average vertebra number in the lumbar calve were 4.8,ranging from 3 to 6.All the patients underwent posterior decompressive laminotomy,pedicle screw fixation,and pesterolateral fusion.The fusion levels were within the curve in all the cases(mean 3.3 vertebrae),without exceeding the end vertebrae.All the patients took standing lumbar antero-posterior and sagittal radiological images pre and post-surgery and upon follow up.The coronal scoliosis Cobb angle,anterior and sagittal intervertebral angles of upper adjacent segment of proximal fused vertebra were megsured.The following aspects were also evaluated such as bone graft fusion and complications.Results Follow up period of 25-97 months,average 50 months;post-opermive scoliosis Cobb angle average correction rate was 33.7%,final follow up average collection loss was 3.7°,pre-operative and final follow up results compared with post-operative indicated significant difference(P<0.05); final follow-up antero-posterior proximal upper fusion segment intervertebral angle compared with pre-operative and postoperative presenting significant difference(P<0.05).Upon final follow up,all cases did not present pseudo-arthrosis or internal instrumentation related complications.Conclusion For degenerative lumbar scoliosis,short-segment fusion can produce limited correction on antero-posterior proximal upper fusion segment intervertebral angle and cannot stop its aggravation.