The Analysis Of The Relevant Indexes Of The X-ray Plates In The Early Stage After Posterior-instrumentation Operations On Lumbar4～5

Objective:The thesis aims to give an objective evaluation of the characteristic of posterior lumbar interbody fusion internal fixation and the influence of operation to the construction and function of lumbar through measuring the selected indexes of Pro and Post operation X-ray. Furthermore, the relation between general lumbar structure variation and curative effect will be analyzed based on the actual curative effect. The purpose of the research is to evaluate objectively the curative effect of lumbar operations and to improve the surgical procedure and postoperative management issues.Methods:Cases of 40 patients who had experienced L4/5 disc removal, intervertebral bone graft fusion and posterior lumbar interbody fusion internal fixation were collected for study. There are 19 male and 21 female patients aged from 42 to 72, of which 28 cases of L4/5lumbar intervertebral disc herniation and spinal stenosis,12 cases of lumbar spondylolisthesis. The following-up period is 12 to 24 months after operation, during which the lumbar correlation indexes was recorded, including the ante-protruding index, sacrum slant angle, lumbosacral angle and L3/4 intervertebral space altitude etc. The relation between the curative effect and the correlation indexes is studied according to the follow-up investigation. Statistics are collected and analyzed by image processing system and SPSS 13.0 statistical software.Results:Posterior lumbar interbody fusion in treatment of L4/5 lumbar disc herniation and spinal stenosis or lumbar spondylolisthesis, the excellent rate was 95% in two years. Analyses statistically the measuring data of lumbar side position piece, As a result:1. After operation, lumbar lordotic angle,sacral slope angles were improved(P< 0.05), L3/4 intervertebral space altitude decreased(P<0.05), lumbosacral angle showed no significant differences (P>0.05) resulted from the operation.2. By testing, the lumbosacral angle of the group of lumbar disc herniation and spinal stenosis and the group of lumbar spondylolisthesis was found different after the surgery (P<0.05).In group of lumbar disc herniation and spinal stenosis, lumbosacral angle increased; in group of lumbar spondylolisthesis, lumbosacral angle decreased. Lumbar lordotic angle, sacral slope angles, L3/4 intervertebral space altitude showed no nificant differences before and after the operation (P>0.05)3.1 or 2 years after the operation, lumbar lordotic angle, sacral slope angles, lumbosacral angle, L3/4 intervertebral space altitude showed no significant difference (P>0.05)4. In the two years of postoperation,the painful symptom of the patient is not directly connected to the change of the space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle, L3/4 intervertebral after the operation (P >0.05)5. The space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle and L3/4 intervertebral showed no significant differences before the operation in the group of lumbar disc herniation and spinal stenosis and the group of lumbar spondylolisthesis (P>0.05)6. After the surgery, lumbar lordotic angle, sacral slope angles showed no significant differences in the group of lumbar disc herniation and spinal stenosis. In the group of lumbar spondylolisthesis (P>0.05), the space altitude of lumbosacral angle, L3/4 intervertebral have changed (P<0.05).In the group of lumbar disc herniation and spinal stenosis, the space altitude of lumbosacral angle and L3/4 intervertebral is greater than the group of lumbar spondylolisthesis after the operation.Conclusion:PLIF operation is one of the efficient methods to treat the L4/5 lumbar disc herniation and spinal stenosis or lumbar spondylolisthesis.1. The operation can improve the lumbar lordotic angle and sacral slope angles, and the function of lumbar spine can recover.2. The L4-5 PILF operation can narrow the space with the upper adjacent segment, from which the conclusion can be drawn that PILF operation leads to ASD of the upper adjacent segment.3. The ASD of the lower adjacent segment is not obvious within the two years after the L4-5 PLIF operation.4. In the two years of postopration,the follow-up result showed that remnant symptom has no direct correlation with the intervertebral space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle and L3/4.