单节段腰椎固定融合术后相邻节段退变相关因素分析及其与临床效果关系

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  目的:探讨单节段腰椎固定融合术后上位相邻节段退变与临床效果的关系,并分析退变的相关因素.方法:回顾性研究2004年10月~2009年5月采用后路单节段椎弓根钉固定并椎体间Gage植入融合术治疗的49例腰4/5退变性失稳患者,男22例,女27例,年龄28~72岁(平均53.4岁).所有患者术前均行骨密度检测.通过拍摄X线片,测量固定节段及其上位相邻节段椎间盘高度、椎间隙动态角度变化、椎体滑移距离以及固定节段和腰椎前凸角、腰骶关节角,并通过JOA评分及腰功能障碍指数(ODI)评价临床效果.根据最后随访相邻节段有无影像学退变,分为退变组与非退变组.比较两组间临床效果及影像学测量结果,分析相邻节段影像学退变的影响因素.结果:随访时间为13-52个月,平均为29.3个月,所有患者术后均无神经损害加重症状.11例患者(22%)出现上位相邻节段影像学退变.两组患者术前腰椎前凸角、腰骶关节角、腰4/5前凸角和椎体间滑移距离相比较均无显著性统计学差异(P>0.05).两组患者最后随访ODI、JOA评分恢复率亦无显著性差异(P>0.05).患者年龄与最后随访固定相邻节段椎间盘高度、椎间隙动态成角、椎体间滑移距离变化值存在正相关性,相关系数分别为:0.353、0.521、0.472.余测量指标与固定相邻节段影像学指标变化均无明显相关性.结论:单节段腰椎固定融合术后上位相邻节段影像学退变与临床效果之间无显著相关性.年龄与此退变相关,而骨密度和术前腰椎影像学测量指标与此退变之间可能无显著的相关性.
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