【作者】 刘国华；

【导师】 沈忆新；

【作者基本信息】 苏州大学 ， 临床医学（专业学位）， 2014， 硕士

【摘要】 目的观察腰椎后路单节段融合内固定术后＞2年邻近节段退变的程度，讨论其影响因素。方法随访2009年4月至2011年5月收治的采用PLIF、TLIF两种术式治疗的退行性腰椎疾病患者的临床资料（60例），根据手术节段分为A组（L4/5融合）44例和B组(L5/S1融合)16例。按手术方式分为PLIF组（47例）与TLIF组（13例）。随访时间24～36月，平均29.3个月。采用疼痛视觉模拟评分(visual analog scale，VAS)、日本骨科学会（Japanese OrthopaedicAssociation,JOA）评分评估患者术后功能改善情况。用末次随访的X线及MRI评估邻近节段退变发生率及程度。结果腰椎固定融合术后头侧邻近节段退变的发生率A组15.9%（7/44）和B组18.8%（3/16)，A组尾侧邻近节段退变的发生率6.8%(3/44)；PLIF术和TILF术后头侧邻近节段退变的发生率分别为17.0%（8/47）和15.4%(2/13)。所有患者术后JOA评分较术前均有明显提高，但邻近节段退变与JOA评分之间没有明显关联。结论：腰椎后路固定融合术后头侧较尾侧更易发生ASD，影像学ASD与融合术后临床效果无明显关系，“悬浮固定”并未增加ASD风险。更多还原

【Abstract】 Objective：To observe the degenarative changes of the adjacent segment in patients whichhad been anderwent posterior lumbar fusion2years ago,and to investigate the impact ofthese changes and their causes.Methods： A total60patients who anderwent L4/5or L5/S1posterior lumbar fusion(PLIF or TLIF)during2009to2011were enrolled to investigate the degenerative changesof the adjacent segment(L3/4or L4/5or L5/S1) through their X-ray film and MRI.Theywere divided into group A (L4/5fusion) of44cases and group B (L5/S1fusion) of16cases according to the fusion section.According to the fusion technique, they were dividedinto PLIF (47cases) and TLIF group (13cases).The follow-up time ranged from24～36months(average，23.9months).The visual analog scale(VAS),Japanese OrthopaedicAssociation(JOA） and ASD were evaluated.The final X-ray and MRI were used to assessthe incidence of adjacent segment degeneration and degree.Results： The cranial degeneration of adjacent segment to fixed lumbar segment wasabserved in15.9%（7/44）in group Aand18.8%（3/16) in group B,respectively.The caudaldegeneration of adjacent segment was abserved in6.8%(3/44) in group A.The cranialdegeneration of adjacent segment to fixed lumbar segment was abserved in17.0%（8/47）in group PLIF and15.4%(2/13) in group TLIF,respectively.The JOA scores of all patientswere obviously improved after operation.But there was no correlation between the JOAscore and the adjacent segment degeneration.Conclusion： The cranial incidence of ASD has a higher risk than thecaudal,s.Floating fusion does not increase the risk ofASD.更多还原