CAJ | 학술논문

目的分析腰椎后路椎弓根螺钉固定术后近端邻近节段前凸的可能原因,探讨合理的应对措施.方法回顾分析2001年12月至2005年8月345例进行腰椎后路椎弓根螺钉患者,根据Oswestry功能障碍指数评价患者的临床效果,影像学检查观察近端邻近节段前凸情况,测量邻近节段椎间角、腰前凸角、腰骶角,并分析年龄、融合节段范围、腰骶力线对近端邻近节段前凸形成的影响.结果全部患者随访2～6年(平均3.8年),术后Oswestry功能障碍指数为9.7～46.2(平均19.6±10.7).78例(22.6%)术后出现近端邻近节段前凸,37例(10.7%)出现临床症状,21例(6.1%)接受再次手术.年龄大于60岁、术后腰前凸减小、垂直骶骨的患者近端椎间角前凸发生率较高,而与固定节段数目无明显关系.结论腰椎短节段后路固定对恢复生理曲度无明显作用,年龄大于60岁、腰前凸减小、骶骨垂直可能是近端邻近节段前凸的危险因素.
목적 분석요추후로추궁근라정고정술후근단린근절단전철적가능원인,탐토합리적응대조시.방법 회고분석2001년12월지2005년8월345례진행요추후로추궁근라정환자,근거Oswestry공능장애지수평개환자적림상효과,영상학검사관찰근단린근절단전철정황,측량린근절단추간각、요전철각、요저각,병분석년령、융합절단범위、요저력선대근단린근절단전철형성적영향.결과 전부환자수방2～6년(평균3.8년),술후Oswestry공능장애지수위9.7～46.2(평균19.6±10.7).78례(22.6%)술후출현근단린근절단전철,37례(10.7%)출현림상증상,21례(6.1%)접수재차수술.년령대우60세、술후요전철감소、수직저골적환자근단추간각전철발생솔교고,이여고정절단수목무명현관계.결론 요추단절단후로고정대회복생리곡도무명현작용,년령대우60세、요전철감소、저골수직가능시근단린근절단전철적위험인소.
Objective To analyze the possible reasons for proximal junctional lordosis(PJL)after short-segment posterior pedicle screw fixation in lumbar spine and discuss its proper management.Methods From December 2001 to August 2005,345 patients were treated by short-segment pedicle screw fixation and these patients were reviewed.Clinical outcome was evaluated according to Oswestry Disability Index(ODI).Proximal junctional lordosis was assessed evaluated on radiographs,by measuring lumbar lordosis angle,segmental angle at proximal level and lumbar-sacral angle.Risk factors of proximal junctional lordosis were analyzed.Resuits All patients were followed-up for 2 to 6 years(average 3.8 years).ODI after lumbar surgery was 9.7-46.2(average 19.6±10.7).PJL was noted in 78 patients(22.6%),37(10.7%)of whom were symptomatic and 21(6.1%)received revision surgery.PJL was more commonly occurred in patients over 60 years old,with reduced lumbar lordosis or veaical sacrum.The number of fusion-segment was not correlated to the occurrence of PJL.Conclusions Short-segment posterior pediele screw fixation can not improve lumbar sagittal alignment.Age over of 60 years,reduced lumbar lordosis and vertical sacrum are possible risk factors of PJL sacrum.