CAJ | 학술논문

目的探讨X线片和三维CT(3D-CT)在判定单节段后路腰椎椎间融合术后椎间融合情况的临床价值.方法选取接受后路腰椎椎间融合术并随访1年以上的患者43例,男19例,女24例;年龄16～74岁,平均47.2岁.峡部裂性滑脱21例,退变性滑脱15例,腰椎间盘突出并不稳症3例,腰椎间盘突出症复发3例,极外侧椎间盘突出症1例.单纯骨粒植骨26例,骨粒加椎间融合器17例.单节段内固定24例,双节段内固定19例.均为单节段椎间融合,其中L_(3,4) 6例,L_(4,5),17例,L_5S_1 20例.应用改良Brantigan评分判定腰椎正侧位X线片及3D-CT扫描所示椎间融合程度;动力位X线片判断椎间稳定性.结果随访12～85个月,平均18个月.末次随访时X线片及3D-CT所示椎间融合率分别为64%(28/43例)和40%(17/43例).3D-CT的Brantigan评分小于正侧位X线片(P<0.05).根据诊断、固定节段及融合方式不同分组,各组3D-CT评分均低于正侧位X线片(P<0.05).动力位X线片示椎间不稳定者仅3例(7%).结论腰椎3D-CT能更准确地评价椎间融合情况.拆除内固定前进行3D-CT检查非常必要.拆除内固定前摄动力位X线片对判定椎体间融合的临床意义不大.
목적 탐토X선편화삼유CT(3D-CT)재판정단절단후로요추추간융합술후추간융합정황적림상개치.방법 선취접수후로요추추간융합술병수방1년이상적환자43례,남19례,녀24례;년령16～74세,평균47.2세.협부렬성활탈21례,퇴변성활탈15례,요추간반돌출병불은증3례,요추간반돌출증복발3례,겁외측추간반돌출증1례.단순골립식골26례,골립가추간융합기17례.단절단내고정24례,쌍절단내고정19례.균위단절단추간융합,기중L_(3,4) 6례,L_(4,5),17례,L_5S_1 20례.응용개량Brantigan평분판정요추정측위X선편급3D-CT소묘소시추간융합정도;동력위X선편판단추간은정성.결과 수방12～85개월,평균18개월.말차수방시X선편급3D-CT소시추간융합솔분별위64%(28/43례)화40%(17/43례).3D-CT적Brantigan평분소우정측위X선편(P<0.05).근거진단、고정절단급융합방식불동분조,각조3D-CT평분균저우정측위X선편(P<0.05).동력위X선편시추간불은정자부3례(7%).결론 요추3D-CT능경준학지평개추간융합정황.탁제내고정전진행3D-CT검사비상필요.탁제내고정전섭동력위X선편대판정추체간융합적림상의의불대.
Objective To evaluate the clinical application of three dimensional computed tomography (3D-CT) and radiographs in assessment of interbody fusion after posterior lumbar intervertebral fusion (PLIF). Methods Forty-three patients, consisting of 19 males and 24 females were treated with PLIF in single segment from March 2000 to June 2007. The mean age was 47.2 years. The interbody fusion was performed by autograft in 26 cases and autograft plus PEEK cages in 17 cases. The preoperative diagnosis were isthmus spondylolisthesis in 21 cases, degenerative spondylolisthesis in 15 cases, Lumbar disc herniation associated with instability in 3 cases, revision after primary lumbar discectomy in 3 cases, and far lateral disc herniation in 1 cases. The interbody fusion levels were L_(3,4) in 6 cases, L_(4,5) in 17 cases,and L_5S_1 in 20 cases. Twenty-four patients underwent two-level internal fixation, while 19 cases accepted three-level fixation. The posterior, lateral static radiograph, flexion-extension radiographs and 3D-CT were performed at follow-up visit . The modified Brantigan grade was used to assess the fusion rate. The interbody stability was assessed by the flexion-extension radiographs. Results The mean follow-up was 18 months (12-85 months). The fusion rates in X-rays and 3D-CT were 64% and 40%, respectively. The mean Brantigan grade in X-rays and 3D-CT were 2.70±1.10 and 2.19±1.16, respectively. The grade was significantly lower in 3D-CT (P< 0.05). The Brantigan grades in 3D-CT were also significantly lower than those in X-ray between the groups of isthmus spondylolisthesis and degenerative spondylolisthesis, two-level and three-level internal fixation, and autograft only and autograft plus PEEK cages. There were only 3 cases showing dynamic instability. The other cases (93%) had no instability according to dynamic X-rays ,even those were comfirmed of nonunion of the bone graft . Conclusion The lumbar 3D-CT is more accurate in assessment of interbody fusion. It is necessary to perform the 3D-CT before removal of the internal fixation.