腰椎间盘置换术后椎间活动度与相邻节段退变之间的关系

目的研究人工椎间盘置换术后椎间活动范围（range of motion,ROM）与相邻节段退变（adjacent segment degeneration,ASD）之间的关系。方法 1999年12月~2006年12月,44例腰椎退行性疾病患者接受人工椎间盘置换术,其中男18例,女26例;年龄为36~58岁,平均42.3岁。椎间盘退行性病变3例,椎间盘退行性病变合并腰椎椎间盘突出32例,椎间盘突出术后复发9例。手术节段为：L3/L4节段3例,L4/L5节段23例,L5/S1节段18例。对所有患者随访2年以上,测量随访时手术节段和相邻节段的ROM,评价ASD征象,记录手术前后以及末次随访时患者视觉模拟量表（visual analog scale,VAS）评分和Oswestry功能障碍评分。对上述数据进行统计学分析。结果所有患者随访2.0~7.5年,平均5.6年。44例手术患者中5例有ASD征象（11%）。患者末次随访时均无临床症状。所有患者术后ROM为3.6°±1.7°,其中ASD患者的ROM为2.2°±0.8°,无ASD患者的ROM为4.6°±1.5°,二者间的差异有统计学意义（P〈0.05）。患者VAS疼痛评分和Oswestry功能障碍评分与影像学检查有无退变无相关性（P〉0.05）。结论人工腰椎椎间盘置换术后相邻节段有退变征象的患者手术节段的ROM低,但相邻节段有无退变与临床疗效无相关性,可能与随访病例数较少及时间较短有关。

Relationship between range of motion and adjacent segment degeneration after lumbar total disc replacement

Objective To determine the relationship between range of motion (ROM) and adjacent segment degeneration(ASD) after lumbar total disc replacement.Methods From December 1999 to December 2006, 44 patients including 18 males and 26 females underwent total disc replacement, the average age of whom was 42.3 years old (36-58 years old). Results of primary diagnosis were degenerative disc disease in 3 patients and degenerative disc disease accompanied with disc herniation in 32 patients, recurrent herniation after discectomy in 9 patients. Intervertebral discs were replaced at L₃/L₄ in 3 patients, L₄/L₅ in 23 patients, L₅/S₁ in 18 patients. All patients were followed up over 2 years. At the final follow-up, data of ROM at surgical segments and adjacent segments were measured, while symptom of ASD was observed. All the patients were evaluated according to scores of visual analogue scale (VAS) and Oswestry disability questionnaire pre-and postoperatively and at the final follow-up. All data were analyzed statistically.Results All 44 patients were followed up for 2.0-7.5 years (mean 5.6 years), and ASD signs were occurred in 5 (11%) patients. No clinical symptom occurred at the final follow-up. The disability ROM of all patients was 3.3°±2.1°. The ROM was 2.8°±1.3° in the patients with ASD and 4.8°±1.5° in the patients without ASD, and the difference was statistically significant (P<0.05). There was no statistically significant relationship between ASD and clinical outcome in this small sample size-study(P>0.05). Conclusion ROM of surgical segment of patients with ASD after lumbar total disc replacement is lower. But no relationship exist between ASD and clinical curative effect, which may be correlated to the small sample size.