CAJ | 학술논문

目的探讨单节段、双节段和三节段后路椎间融合器置入椎弓根内固定术( posterior lumbar interbody fusion，PLIF )对融合节段邻近节段稳定性的影响。方法回顾性单节段( A组)，双节段( B组)和三节段( C组) PLIF，共45例，对融合节段邻近节段稳定性的影响，每组纳入15例，测量术前、术后腰椎前凸角度及上位邻近节段术前、术后活动度。结果 A组患者末次随访与术前比较，腰椎活动度平均减少10.4°，邻近节段活动度平均增加2.1°；B组患者末次随访与术前比较，腰椎活动度减少11.4°，邻近节段活动度平均增加1.9°；C组患者末次随访与术前比较，腰椎活动度减少16°，邻近节段活动度平均增加8.1°。融合邻近节段活动度，A组：术前(3.6±2.0)°，术后(6.5±1.6)°；B组：术前(8.4±5.5)°，术后(9.8±9.5)°；C组：术前(5.0±4.5)°，术后(13.0±7.6)°，差异均有统计学意义( P＜0.01)。3组术后邻近节段活动度组间比较，差异有统计学意义( P＜0.01)。结论随着融合节段增加，邻近节段活动度也随之增加。根据术前腰椎前凸角度，术中适度恢复腰椎生理前凸角度，是维持邻近节段稳定性的有效方法。
목적탐토단절단、쌍절단화삼절단후로추간융합기치입추궁근내고정술( posterior lumbar interbody fusion，PLIF )대융합절단린근절단은정성적영향。방법회고성단절단( A조)，쌍절단( B조)화삼절단( C조) PLIF，공45례，대융합절단린근절단은정성적영향，매조납입15례，측량술전、술후요추전철각도급상위린근절단술전、술후활동도。결과 A조환자말차수방여술전비교，요추활동도평균감소10.4°，린근절단활동도평균증가2.1°；B조환자말차수방여술전비교，요추활동도감소11.4°，린근절단활동도평균증가1.9°；C조환자말차수방여술전비교，요추활동도감소16°，린근절단활동도평균증가8.1°。융합린근절단활동도，A조：술전(3.6±2.0)°，술후(6.5±1.6)°；B조：술전(8.4±5.5)°，술후(9.8±9.5)°；C조：술전(5.0±4.5)°，술후(13.0±7.6)°，차이균유통계학의의( P＜0.01)。3조술후린근절단활동도조간비교，차이유통계학의의( P＜0.01)。결론수착융합절단증가，린근절단활동도야수지증가。근거술전요추전철각도，술중괄도회복요추생리전철각도，시유지린근절단은정성적유효방법。
Objective To investigate the radiologic stability of adjacent segments after single, double and triple fusion segments of posterior lumbar interbody fusion ( PLIF ). Methods All 45 patients who were treated by PLIF were divided into 3 groups, including group A of single segment, group B of double segments and group C of triple segments, with 15 patients in each group. The effects on the stability of adjacent segments after fusion were retrospectively analyzed. The preoperative and postoperative lumbar lordosis angle and range of motion ( ROM ) of upper adjacent segments were measured. Results The results showed the lumbar ROM was decreased in the latest follow-up when compared with that preoperatively by 10.4° in group A, 11.4° in group B and 16° in group C on average. And the ROM of adjacent segments was increased in the latest follow-up when compared that preoperatively by 2.1° in group A, 1.9° in group B and 8.1° in group C on average. The preoperative ROM of adjacent segments was ( 3.6±2.0 ) °, ( 8.4±5.5 ) ° and ( 5.0±4.5 ) ° in group A, group B and group C, and the postoperative ROM was ( 6.5±1.6 ) °, ( 9.8±9.5 ) ° and ( 13.0±7.6 ) ° respectively. The differences between the preoperative and postoperative ROM in each group were statistically signiifcant ( P<0.01 ), and the differences of the postoperative ROM among all groups were statistically signiifcant ( P<0.01 ). Conclusions With the adding of fusion segments, the ROM of adjacent segments also increases. Based on the preoperative lumbar lordosis angle, a modest recovery of the physiological lordosis angle is achieved during the operation. It is an effective method to maintain the stability of adjacent segments.