摘要
目的观察椎板切除对腰椎长节段固定减压术后上位邻近节段退变(ASD)的影响。方法回顾性分析2014年1月至2016年12月郑州大学第一附属医院骨科行腰椎长节段固定减压术的退行性腰椎管狭窄症患者41例,根据术中是否切除头端固定椎体后方椎板分为两组:端椎后方椎板术中被切除者为A组(25例),端椎后方椎板术中未被切除者为B组(16例)。比较两组术前及末次随访时的ODI和JOA评分,端椎上位椎间隙高度,端椎上位椎体滑移距离等。结果随访期间两组患者均未出现需二次手术干预的ASD。末次随访,A组患者ODI、JOA评分与B组比较,差异无统计学意义(P> 0. 05)。末次随访,两组患者ODI评分均低于术前,JOA评分均高于术前,差异有统计学意义(均P <0. 05)。末次随访,两组患者端椎上位椎间隙高度比较,差异无统计学意义(P> 0. 05)。末次随访,A组端椎上位椎体滑移距离大于B组,差异有统计学意义(P <0. 05)。A组端椎上位椎间隙高度丢失值大于B组,A组端椎上位椎体滑移距离增加程度高于B组,差异有统计学意义(均P <0. 05)。结论对退行性腰椎管狭窄症长节段固定术后的患者进行短期随访发现,术中切除端椎后方椎板更易发生影像学上位ASD,端椎后方椎板的完整保留对减少上位邻近节段影像学退变有积极作用。
Objective To observe the influence of laminectomy on upper adjacent segment degeneration(ASD)following lumber long-segment fixation and decompression surgery.Methods A total of 41 patients with degenerative lumbar stenosis who underwent long-segment fixation and decompression were retrospectively studied from January of 2014 to December of 2016 in the First Affiliated Hospital of Zhengzhou University.Two groups were divided according to lamina maintenance of proximal fixed vertebra in surgery.There were 25 patients in group A who underwent laminectomy of proximal fixed vertebra,and 16 patients in group B whose lamina of proximal fixed vertebra were not resected in surgery.Before and at the last follow-up,the scores of Oswestry disability index(ODI)and Japanese Orthopaedic Associcotion(JOA),upper disc height and vertebra slip distance of proximal fixed vertebrae were compared between the two groups.Results During the follow-up period,no ASD requiring secondary surgical intervention occurred in both groups.At the last follow-up,there were no significant differences in ODI and JOA scores between group A and group B(P>0.05).At the last follow-up,the score of ODI in the two groups was lower than that before operation and the score of JOA was higher than that before operation,while the differences were statistically significant(all P<0.05).There was no significant difference in the height of the superior intervertebral space between the two groups at the last follow-up(P>0.05).At the last follow-up,the distance of upper vertebral body slippage in group A was greater than that in group B,and the difference was statistically significant(P<0.05).Group A had statistically significant more decrease of upper disc height and more increase of vertebral slip distance than group B,and the differences were statistically significant(all P<0.05).Conclusion In short-time follow-up of degenerative lumbar stenosis following long-segment fixation and decompression surgery,laminectomy of proximal fixed vertebrae is more likely to occur
作者
马招鑫
皮国富
孙建广
黄世磊
李峰
孙坚皓
Ma Zhaoxin;Pi Guofu;Sun Jianguang;Huang Shilei;Li Feng;Sun Jianhao(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2018年第24期4433-4435,共3页
Henan Medical Research
关键词
腰椎管狭窄症
邻近节段退变
长节段
椎板切除术
lumbar spinal canal stenosis
adjacent segment degeneration
long segment
laminectomy
