腰椎后路单节段固定融合术后邻近节段关节突关节退变的随访观察

Adjacent facet joint degeneration after posterior single-level lumbar fusion: a mid-term follow-up

中文关键词:  腰椎  脊柱融合术  邻近节段退变  关节突关节  随访研究

英文关键词:Lumbar  Spinal fusion  Adjacent segment degeneration  Facet joint  Follow-up study

中文摘要:

  【摘要】 目的：分析单节段后路腰椎固定融合（PLIF）术后邻近节段关节突关节（facet joint，FJ）退变的影像学特征，探讨PLIF对融合邻近节段FJ退变的影响。方法：选取2005年1月～2014年1月采用单节段PLIF或单纯髓核摘除术治疗的患者共84例，其中PLIF组（A组）44例，手术邻近节段共140个关节突关节；髓核摘除组（B组）40例，手术邻近节段共122个关节突关节。观察两组患者手术前后病变邻近节段FJ的CT和MRI影像学特征及退变发生率，依据Weishaupt分级系统对FJ进行分级，采用行平均分差检验，对两组患者手术前后病变邻近节段FJ的退变程度进行组内和组间比较。结果：两组患者的性别比、年龄、随访时间及手术节段差异均无统计学意义（P>0.05）。FJ退变常见的影像学表现为骨赘形成、关节间隙狭窄、软骨下骨的侵蚀、软骨下囊肿、关节突关节对位不良、关节突关节空气征、关节突关节积液、关节突再塑形以及关节突关节融合。A组术前关节间隙狭窄、软骨下骨的侵蚀发生率分别为52.9%、31.4%，术后为75.7%、62.1%；B组术前关节间隙狭窄、软骨下骨的侵蚀发生率分别为51.6%、30.3%，术后为63.9%、50%。两组患者关节间隙狭窄、软骨下骨的侵蚀术前发生率无统计学差异；术后两组发生率均较术前显著性增加（P<0.05），且两组间比较差异有统计学意义（P<0.05）。按照Weishaupt分级，A组140个关节突关节中，术前0级3个，1级95个，2级34个，3级8个，退变发生率为97.9%；术后0级1个，1级49个，2级59个，3级31个，退变发生率为99.3%；B组122个关节突关节中，术前0级4个，1级82个，2级30个，3级6个，退变发生率为96.7%；术后0级2个，1级60个，2级39个，3级21个，退变发生率为98.4%，两组手术前后退变发生率差异均无统计学意义（P>0.05）。采用行平均分差检验，两组患者组内手术前后对比，术后退变程度加重，与术前比较均有统计学差异（P<0.05）；两组间比较，A组术前FJ退变程度与B组术前无统计学差异（P>0.05）；但A组术后FJ退变程度评分较B组术后评分高，差异有统计学意义（P<0.05）。结论：腰椎后路单节段固定融合术可能会加速邻近节段关节突关节的退变，以关节间隙狭窄和软骨下骨的侵蚀最为常见。

英文摘要:

  【Abstract】 Objectives: To analyze the degenerative imaging features of adjacent facet joints after posterior single-level lumbar interbody fusion(PLIF), and to discuss the effect of PLIF on the degeneration of adjacent facet joints. Methods: From January 2005 to January 2014, 84 patients who underwent single-level PLIF (group A) or mere discectomy(group B) were collected． There were 44 patients with 140 adjacent facet joints in group A and 40 patients with 122 adjacent facet joints in group B． The degenerative imaging features and the incidence of adjacent facet joint were investigated on CT and MRI before and after surgery. The degenerative degree of facet joint was evaluated by Weishaupt grading system, analyzed by Cochran-Mantel-Haenszel statistics and compared within and between groups. Results: There was no statistical difference in sex ratio, age, follow-up time or surgical segment between the two groups(P>0.05)． The common radiographic appearances of facet joint degeneration were osteophyte formation, joint-space narrowing, subchondral erosion, subchondral cyst, joint malalignment, joint-space vacuum phenomenon, joint effusion, joint remodeling and joint fusion. The preoperative incidence of joint-space narrowing and subchondral erosion in group A was 52.9% and 31.4%, and increased to 75.7% and 62.1% postoperatively; that was 51.6% and 30.3% in group B preoperatively, and increased to 63.9% and 50% postoperatively. The incidence of joint-space narrowing and subchondral erosion between the two groups had no significant difference preoperatively(P>0.05), but it increased and had a significant difference between the two groups(P<0.05). According to Weishaupt grading system, among 140 joint facet joints in group A, 3 were of grade 0, 95 were of grade 1, 34 were of grade 2, 8 were of grade 3, with a degenerative incidence of 97.9% before surgery. While after surgery, 1 was of grade 0, 49 were of grade 1, 59 were of grade 2, 31 were of grade 3, with a degenerative incidence of 99.3%. Among 122 joint facet joints in group B, 4 were of grade 0, 82 were of grade 1, 30 were of grade 2, 6 were of grade 3, with a degenerative incidence of 96.7% before surgery. While after surgery, 2 were of grade 0, 60 were of grade 1, 39 were of grade 2, 21 were of grade 3, with a degenerative incidence of 98.4%. There was no significant difference of degenerative incidence before and after surgery in the two groups(P>0.05). Analyzed by Cochran-Mantel-Haenszel statistics, the degenerative degree of facet joint in the two groups aggravated after surgery, with a significant difference compared with that before surgery. The preoperative degenerative degree of facet joint had no significant difference between the two groups(P>0.05), while the postoperative degenerative degree had a significant difference(P<0.05), with more severe degenerative degree in patients of group A. Conclusions: The adjacent facet joint degeneration may accelerate after posterior single-level lumbar fusion, which most commonly shows as joint-space narrowing and subchondral erosion.