L<sub>4～5</sub>融合后影像学参数改变与疗效的影响因素分析

Abstract
Figure/Table
References (0)
Related Citation (15)

Download: PDF (1461 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore changes of sagittal parameters and clinical outcome after L_4～5 single segment fusion，and to analyze the influencing factors of clinical efficacy.Methods 46 patients (29 men and 17 women) who had complete followup date and received transforaminal lumbar interbody fusion (TLIF) of L_4～5single segment in our hospital between January 2010 and January 2011 were enrolled in the study.The average age were (52.3±11.0) and the mean follow-up was (39.2±11.1)months(25～58 months) .The pain status of the lower limbs and the lower back pain were assessed by visual analogue scale (VAS)，the functional status was assessed by the Oswestry Dysfunction Index (ODI)，and sagittal parameters were measured using standing fulllength lateral radiographs before surgery，at the third month after surgery and final follow up respectively.The relationship between clinical efficacy and sagittal parameters was analyzed.Results The VAS scores of lower limbs and low back pain and the ODI scores were all lower at the third month after operation and the last follow-up than those before operation and the differences were statistically significant (P＜0.05).There were no statistically significant differences for thoracic kyphosis (TK) and pelvic incident (PI) at 3 months and the last follow-up compared with those before surgery.The lumbar lordosis (LL)，sacral slope (SS)，PI-LL，L_4～5 intervertebral height and intervertebral angle were significantly higher at the third month after surgery than those before operation and the differences were statistically significant (P＜0.05).At the last follow-up，LL，L_4～5 intervertebral height and intervertebral angle were significantly higher than those before operation，PT and PI-LL were less than preoperative，and the differences were statistically significant (P＜0.05).Logistic regression analysis showed that LL，SS，L_4～5 intervertebral height and intervertebral angle were the factors that affected the clinical efficacy.Clinical results were better in patients with greater LL，SS，L_4～5 intervertebral height and intervertebral angle.Conclusion TLIF of L_4～5 single segment can achieve good clinical results and improve the sagittal alignment.LL，SS，L_4～5 intervertebral height and intervertebral angle are important factors affecting clinical efficacy and should be fully considered in the development of surgical strategy.

Key words： single segment fusion surgery sagittal parameters clinical efficacy

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2017/V23/I11/970

［1］Harms JG，Jeszenszky D.Die posteriore，lumbale，interkorporelle fusion in unilateraler transforaminaler technik［J］.Oper Orthop Traumatol，1998，10(2)：90-102.
［2］Humphreys SC，Hodges SD，Patwardhan AG，et al.Comparison of posterior and transforaminal approaches to lumbar interbody fusion［J］.Spine (Phila Pa 1976)，2001，26(5)：567-571.
［3］Mi KK，Lee SH，Kim ES，et al.The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis：A Pilot study［J］.BMC Musculoskelet Disord，2011，12(1)：69.
［4］李柱海，曾建成，聂鸿飞，等.普瑞巴林联合塞来昔布治疗腰椎间盘突出症经皮内镜术后神经病理性疼痛的疗效观察［J］.中国修复重建外科杂志，2017，31(2)：215-221.
［5］保国锋，李卫东，徐冠华，等.经皮椎板间隙入路270°椎管减压治疗腰椎管狭窄症［J］.中国矫形外科杂志，2017，25(3)：264-269.
［6］Tye EY，Alentado VJ，Mroz TE，et al.Comparison of clinical and radiographic outcomes in patients receiving single-level transforaminal lumbar interbody fusion with removal of unilateral or bilateral facet joints［J］.Spine (Phila Pa 1976)，2016，41(17)：E1039.
［7］Lee WC，Park JY，Kim KH，et al.Minimally invasive transforaminal lumbar interbody fusion in multilevel：comparison with conventional transforaminal interbody fusion［J］.World Neurosurg，2015(85)：236-243.
［8］Sembrano JN，Yson SC，Horazdovsky RD，et al.Radiographic comparison of lateral lumbar interbody fusion versus traditional fusion approaches：analysis of sagittal contour change［J］.Int J Spine Surg，2015(9)：16.
［9］Talia AJ，Wong ML，Lau HC，et al.Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis［J］.J Clin Neurosci，2015，22(11)：1762-1770.
［10］Lee CK.Accelerated degeneration of the segment adjacent to a lumbar fusion［J］.Spine (Phila Pa 1976)，1988，13(3)：375-377.
［11］Kepler CK，Rihn JA，Radcliff KE，et al.Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion［J］.Orthop Surg，2012，4(1)：15-20.
［12］Barrey C，Roussouly P，Huec JCL，et al.Compensatory mechanisms contributing to keep the sagittal balance of the spine［J］.Eur Spine J，2013，22(6)：S834.
［13］Schwab F，Ungar B，Blondel B，et al.SRS-schwab adult spinal deformity classification：a validation study［J］.Spine (Phila Pa 1976)，2012，37(12)：1077-1082.
［14］Aoki Y，Nakajima A，Takahashi H，et al.Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion［J］.BMC Musculoskelet Disord，2015，16(1)：213.
［15］孙祥耀，张希诺，海涌.退变性脊柱侧凸术后骨盆投射角与腰椎前凸角匹配程度与临床疗效的关系［J］.中国骨与关节杂志，2017，6(1)：20-26.
［16］李危石，费晗，陈仲强，等.退变性腰椎侧凸患者腰椎前凸矫正程度与疗效的关系［J］.中国脊柱脊髓杂志，2016，26(10)：912-918.
［17］Lee DY，Jung TG，Lee SH.Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients［J］.J Neurosurg Spine，2008，9(2)：137-144.
［18］Jagannathan J，Sansur CA，Jr OR，et al.Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion［J］.Neurosurgery，2009，64(5)：955-963.
［19］焦海斌，胡学昱，黄培培，等.L_4～5单节段融合对不同腰椎Roussouly分型腰椎骨盆矢状位参数和临床疗效的影响［J］.中国脊柱脊髓杂志，2015，25(5)：405-414.
［20］Akeda K，Yamada T，Inoue N，et al.Risk factors for lumbar intervertebral disc height narrowing：a population-based longitudinal study in the elderly［J］.BMC Musculoskelet Disord，2014，16(1)：1-9.