| 引用本文： |
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马敏,吴德升,黄宇峰,等.腰椎融合术后邻近节段退变的长期随访观察[J].同济大学学报（医学版）,2014,35(5):51-55. [点击复制]
- MA Min'2,WU De-sheng2,HUANG Yu-feng2,et al.Long-term outcomes and postoperative adjacent segment degeneration following lumbar fusion in elderly patients[J].同济大学学报（医学版）,2014,35(5):51-55. [点击复制]
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| 摘要: |
| 目的分析老年患者后路腰椎融合内固定术后邻近节段退变（adjacent segment degeneration,ASD）的影响因素与长期随访结果。方法回顾性分析1999年3月至2006年6月因腰椎退变性疾病行腰椎后路融合椎弓根钉内固定术的老年患者（年龄〉60岁）83例,观察ASD的发生率并分析术前邻近节段椎间盘退变与否、融合位置、融合范围及是否＂悬浮固定＂对邻近节段退变的影响。结果所有患者随访84~127个月,平均104.7个月。共有24例（28.9%）患者出现ASD的影像学表现,其中18例发生于融合节段近端,6例发生于远端。术前存在邻近节段椎间盘退变以及高位腰椎（固定的最近端椎体为L1~L3）融合均为术后ASD出现的危险因素（P〈0.05）,而性别、融合范围以及是否行＂悬浮固定＂对ASD的影响无统计学意义（P〉0.05）。术后未出现ASD的患者在末次随访时的Oswestry伤残指数（Oswestry disability index,ODI）及腰椎JOA评分（Japanese orthopaedic association scores,JOA）的改善率均优于出现ASD的患者,且差异有统计学意义（P〈0.05）。结论术前邻近节段椎间盘状态、融合部位与术后ASD发生率存在一定相关性,ASD对腰椎融合术的远期预后具有明显影响。 |
| 关键词: 腰椎 融合内固定 邻近节段退变 老年人 |
| DOI：10.3969/j. issn!008 -0392.2014.05.011 |
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| 基金项目:上海市科委生物医药重点项目（12411951202） |
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| Long-term outcomes and postoperative adjacent segment degeneration following lumbar fusion in elderly patients |
| MA Min'2,WU De-sheng2,HUANG Yu-feng2,BA ZJhao-yu1,ZHAO Wei-dong2 |
| (School of Medicine, Tongji University, Shanghai 200092, China; 2. Dept. of Orthopedics, East Hospital, Tongji University, Shanghai 200120, China) |
| Abstract: |
| Objective To evaluate the long-term clinical outcomes and postoperative adjacent degenerative segments（ ASD） after lumbar fusion in elderly patients. Methods From M arch 1999 toJune 2006,83 patients over 60 of age with lumbar degenerative disease were treated by posterior lumbar fusion in our hospital. The correlations of ASD occurrence with gender,range of fixation,position of fixation,＂floatingfusion ＂,and preoperative adjacent disc regeneration were analyzed.Results All patients were followed up for 84-127 months with a mean of 104. 7 months. Radiographic ASD occurred in 28. 9%（ 24 of 83） of patients including18 cases were noted that ASD occurred proximal tothe prior fusion and 6 patients distally,respectively. Fusion of L1-L3 proximally and preoperative adjacent disc degeneration increased the risk of ASD,while gender,range of fusion and＂floatingfusion＂were not the risk factors. Patients with radiographic ASD had worse Oswestry disability index（ ODI） and Japanese Orthopedic association scores（ JOA） at last follow-up than those without ASD（ P〈0. 05）. Conclusion Preexistingadjacent disc degeneration is a significant risk factor of ASD in lumbar spine. Fusion up toL1-L3 increases the risk of ASD when compared with L4 and L5. Long-term clinical outcome after lumbar spine fusion is negatively influenced by ASD. |
| Key words: lumbar lumbar spine fusion and internal fixation adjacent segment degeneration elderly people |
