单节段 PLIF 后邻近节段退变：退变的危险因素及其对临床结果的影响。
Adjacent segment degeneration after single-segment PLIF: the risk factor for degeneration and its impact on clinical outcomes.
机构信息
Department of Spinal Surgery, First Affiliated Hospital of Sun Yat-Sen University, NO. 183, Huangpu East Road, Guangzhou, Guangdong, China.
出版信息
Eur Spine J. 2011 Nov;20(11):1946-50. doi: 10.1007/s00586-011-1888-1. Epub 2011 Jul 1.
PURPOSE
To investigate: (1) the risk factors for radiologic cranial adjacent segment degeneration (ASD) after single-segment PLIF at the same level, and (2) the impact of the ASD on the clinical outcomes.
METHODS
From October 2004 to May 2009, 109 patients who underwent PLIF for degenerative instability at L4/5 and have more than 2 years follow-up were studied retrospectively. We measured the preoperative bone mineral density (BMD), lumbar lordosis, the lumbosacral joint angle, the lumbar inclination, the height and the dynamic angulation of the intervertebral space at the fused segments and the upper adjacent segment, the sliding displacement between L3 and L4. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and the Oswestry Disability Index (ODI). Patients were divided into two groups according to the progression of L3-L4 degeneration: Group A without progression of L3-L4 degeneration, Group B with progression of L3-L4 degeneration. Clinical outcomes and radiologic measurement index between the two groups were compared, and the risk factors for progression of L3-L4 degeneration were analyzed. The correlation between clinical outcomes and progression of L3-L4 degeneration were also investigated.
RESULTS
There were 11 patients (22%) classified into Group A. No significant difference was found between the two groups in terms of the lordosis angle at L1 and S1, the laminar inclination at L3, the pre-existing L3-L4 disk degeneration, the lordosis angle of L4-L5, the lumbosacral joint angle and preoperative BMD (P > 0.05). Significant differences were found between the two groups in age. No significant difference was found between the two groups in the ODI and the JOA score at the final follow-up (P > 0.05).
CONCLUSION
Radiologic degeneration of the cranial adjacent segment after single-segment PLIF did not significantly correlate with clinical outcomes. Age was a risk factor for radiologic degeneration, however, there was no significant correlation between degeneration and preoperative radiologic factors and bone mineral density (BMD).
目的
研究：（1）单节段 PLIF 治疗同一水平的颅侧相邻节段退变（ASD）的危险因素；（2）ASD 对临床结果的影响。
方法
回顾性分析 2004 年 10 月至 2009 年 5 月因退行性不稳定行 PLIF 治疗的 109 例患者的资料，随访时间超过 2 年。我们测量了术前骨密度（BMD）、腰椎前凸角、腰骶关节角、腰椎倾斜角、融合节段和上相邻节段椎间空间的高度和动态角度、L3 和 L4 之间的滑动位移。临床结果采用日本骨科协会（JOA）评分和 Oswestry 功能障碍指数（ODI）进行评估。根据 L3-L4 退变的进展情况将患者分为两组：A 组无 L3-L4 退变进展，B 组有 L3-L4 退变进展。比较两组间的临床结果和影像学测量指标，并分析 L3-L4 退变进展的危险因素。同时，还研究了临床结果与 L3-L4 退变进展之间的相关性。
结果
A 组有 11 例（22%）患者。两组间 L1 和 S1 的后凸角、L3 的椎板倾斜角、术前存在的 L3-L4 椎间盘退变、L4-L5 的后凸角、腰骶关节角和术前 BMD 无显著差异（P>0.05）。两组间年龄差异有统计学意义（P<0.05）。两组患者终末随访时的 ODI 和 JOA 评分无显著差异（P>0.05）。
结论
单节段 PLIF 后颅侧相邻节段的影像学退变与临床结果无显著相关性。年龄是影像学退变的危险因素，但退变与术前影像学因素和骨密度（BMD）之间无显著相关性。
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