| 颈椎前路融合术后发生症状性邻近节段退变的临床研究 |
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Received:September 25, 2007
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| 期刊信息：《中国骨伤》2007年20卷，第12期，第808-811页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探讨分析与颈椎前路融合术后发生症状性邻近节段退变相关的因素。
方法:自2001年3月-2006年7月共收治354例颈椎病患者,获得随访的263例,其中男185例,女78例,手术时年龄35~76岁,平均51岁,其中神经根型颈椎病54例,脊髓型颈椎病183例,合并两者的有26例。所有患者均接受前路减压、自体髂骨植骨、前路钢板内固定。根据门诊随访,综合评估所有患者的术后临床表现、神经系统及术前术后影像学表现,评价对象包括年龄,性别,融合椎体数,术前颈椎的曲度、活动度,椎管的前后径以及邻近节段的椎间盘突出和椎体前缘骨赘形成等,并根据随访时的侧位X线片将头尾两端邻近椎间隙的骨赘形成程度分为4级,统计学分析引起症状性邻近节段退变的相关因素以及邻近节段退变与骨赘形成程度的关系。
结果:263例患者中有39例（14.8%）出现了症状性邻近节段病变,其中男23例,女16例,手术时年龄42~65岁,平均55岁,从手术后到出现邻近节段病变的时间为4~11年,出现邻近节段病变的平均年龄为61岁。这些症状表现为原有颈椎病症状部分或完全缓解后再次出现与邻近节段椎间盘突出相对应的神经症状与体征,而在原手术节段没有脊髓受压的表现。术前脊髓MRI上邻近节段硬膜有压迹或融合节段头侧邻近节段椎间盘低信号的患者,术后发生症状性邻近节段退变的概率明显高于未出现症状的患者,而年龄,性别,融合椎体数,术前颈椎的曲度,活动度,椎管的前后径等研究对象与症状性邻近节段退变没有明显的相关性（P>0.05）。对于发生症状性邻近节段退变的患者,有26例（67%）钢板头端邻近节段发生了骨化,与尾端骨化相比,P<0.01,骨化程度随临床症状的加重而加重。
结论:对于因颈椎病而行颈椎前路融合钢板内固定的患者,术前脊髓MRI示有邻近节段硬膜有压迹或融合节段头侧邻近节段椎间盘退变表现者,术后容易发生症状性邻近节段退变,这种退变在侧位X线上可表现钢板头端邻近椎间隙骨化。 |
| [关键词]:颈椎病 手术后并发症 骨科手术方法 |
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| Symptomatic adjacent segment disease after anterior cervical interbody fusion |
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Abstract:
Objective:To investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion and identify the factors associated with the development of this disease.
Methods:A total of 354 patients with cervical disease underwent anterior cervical interbody fusion(ACDF) and plate fixation,of which only 263 patients(185 male,78 female)were followed up clinically and radiologically.There were 54 patients with radiculopathy spondylosis,183 patients with myelopathy spondylosis and 26 patients with mixture type with the mean age of 51 years old(range,35 to 76 years old) at surgery.Follow-up evaluation was primarily by means of clinical visit.The postoperative course of any symptoms,the findings of neurological examination and follow-up radiographs were performed in all patients.The correlation between the incidence of symptomatic adjacent segment disease and the following clincal parameters(age at operation,sex,number of the levels fused) and radiological parameters(preoperative cervical spine alignment,preoperative range of motion of C2-C7 cervical spine,anteroposterior spinal canal diameter,preoperative existence of an adjacent segment degeneration on plain radiograph,myelography and magnetic resonance imaging were evaluated.
Results:Symptomatic adjacent segment disease developed in 39 of 263 patients(14.8%).A Kaplan-Meier survival analysis was performed in order to follow the disease-free survival of all patients.The disease-free survival rates were 92% at 5 years,88% at 8 years and 86% at 11 years.The incidences of dura matter indention on preoperative MRI or disc degeneration on MRI at the adjacent level were significantly higher in disease cases(P<0.05).Twenty-six of 39 patients developed cephalad adjacent intervertebral osteophyte formation.However,the other parameters did not show a statistically significant difference.
Conclusion:The incidence of symptomatic adjacent segment disease after ACDF was higher when preoperative myelography or MRI revealed asymptomatic disc degeneration at that cephalad level regardless of the number of the levels fused,preoperative alignment,spinal canal diameter or fusion segment,and this type of disease may has the feature of osteophyte formation cephalad to the plate. |
| KEYWORDS:Cervical spondylopathy Postoperative complications Orthopaedics operative methods |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 蒋欣,谭明生.颈椎前路融合术后发生症状性邻近节段退变的临床研究[J].中国骨伤,2007,20(12):808~811 |
| 英文格式: | JIANG Xin,TAN Ming-sheng.Symptomatic adjacent segment disease after anterior cervical interbody fusion[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(12):808~811 |
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