颈椎疾患_____颈椎疾患；椎体间融合术后；

颈椎前路椎间融合术后邻近节段的病变研究

http://www.100md.com 《中国矫形外科杂志》 2006年第9期

颈椎疾患,,颈椎疾患；椎体间融合术后；,邻近节段病变,摘要,关键词,1资料与方法,2结果,3讨论,参考文献

     摘要：[目的]研究颈椎前路椎间融合术后症状性邻近节段病变的发生率以及预测其发生的因素。[方法]112例颈椎间盘突出症或颈椎病接受颈椎前路椎体间融合术患者，行术后症状的评价，神经学检查及系列放射学检查，分析症状性邻近节段病变的发生率与临床和影像学参数的关系。症状性邻近节段病变的发生率通过KaplanMeier生存分析法进行统计，各参数与症状性邻近节段病变的发生率之间的关系通过u检验和t检验分析。[结果]随访时间2~19 a，平均94 a。112例患者中有19例(17%)出现了症状性邻近节段病变，其中男12例，女7例。KaplanMeier生存分析法分析未出现症状邻近节段病变的患者比率，5 a时比率为89%，10 a时为84%，17 a时为67%。出现症状性邻近节段病变的病例中，术前脊髓造影上邻近节段硬膜有明显压迹或MRI上邻近节段椎间盘突出的发生率明显高于未出现症状性邻近节段病变的病例(P分别为00 087及00 299，双样本t检验)。而其他参数没有显著性差异。7名患者因保守治疗无效而进行了手术。[结论]当术前脊髓造影或MRI显示该节段存在无症状性椎间盘退变时，颈椎前路椎体间植骨融合术后症状性邻近节段病变的发生率明显高，与融合的节段数、术前颈椎曲度、椎管的直径或融合节段的曲度都无关。

     关键词：颈椎疾患；椎体间融合术后；邻近节段病变

    Adjacent segment disease after anterior cervical interbody fusion∥LIU Hong,Hirokazu Ishihara,ZHI HuimingDepartment of Orthopaedics Surgery,Peking University First Hospital,Beijing 100034

    Abstract：[Objective]The present study was undertaken to investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion(ACIF),and to identify the factors which are related to the development of this disease[Method]From 1981 to 1997,a total of 160 patients underwent anterior cervical in terbody fusion for intervertebral disc herniation and cervical spondylosisA total of 112 patients were followed up clinically and radiologically for more than two yearsOf them,74 were men and 38 were women,the average age at operation was 51 years(ranged,31~70 years)Of the 112 patients,66 had one,44 had two and 2 had three levels of fusionFollowup evaluation was primarily viaclinical visitedThe postoperative course of any symptoms,the findings of neurological examination and serial followup radiographs were performed in all patientsThe diagnosis of symptomatic adjacent segment disease was based on the presence of new radiculopathy or myelopathy symptoms referable to an adjacent level,and the presence of a compressive lesion at an adjacent level by magnetic resonance imaging or myelographyWe evaluated the correlation between the incidence of symptomatic adjacent segment disease and the following clinical parameters(age at operation sex,number of the levels fused)and radiological parameters(preoperative cervical spine alignment,preoperative range of motion of C2~7 cervical spine,anteroposterior spinal canal diameter,preoperative existence of an adjacent segment degeneration on plain radiograph,myelography and magnetic resonance imaging(MRI)[Result]The average length of followup was 94 years(ranged,2 to 19 years)Symptomatic adjacent segment disease developed in 19 out of 112 patients(19%)followedA KaplanMeier survival analysis was performed in order to follow the diseasefree survival of the entire series of patientsThe disease free survival rates were 89% at 5 years,84% at 10 years and 67% at 17 yearsThe incidences of indentation of dura matter on preoperative myelography or disc protrusion on MRI at the adjacent level were significantly higher in disease cases(P=00 087,00 299,respectively;Chisquare test)Howerer,the other parameters did not show a statistically significant differenceThere were 7 cases(37%)who had failure of nonoperative treatment and additional operations were performed[Conclusion]The incidence of symptomatic adjacent segment disease after ACIF was higher when preoperative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the level number fused,preoperative alignment,spinal canal diameter of fusion alignment ......

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