腰椎后路单/双节段融合术后上邻近节段关节突关节退变的研究

The study of adjacent segmental facet joint degeneration following single or double-level lumbarspinal fusion

中文关键词:  腰椎融合内固定术  邻近节段退行性变  关节突关节

英文关键词:Lumbar fusion  Adjacent segment degeneration  Facet joint

中文摘要:

  【摘要】 目的：研究腰椎后路单/双节段椎间融合术（posterior lumbar interbody fusion，PLIF）后上邻近节段关节突关节（facet joint，FJ）退变的情况，分析上邻近节段FJ退变的影响因素。方法：回顾性分析2009年1月~2015年12月于我院行PLIF的退行性腰椎疾病患者共49例，男27例，女22例，平均年龄55.4±8.6（41~72）岁，随访时间33.0±6.3（25~43）个月，根据融合节段分为L4/5组26例；L4-S1组23例。收集各组患者性别、年龄、随访时间、吸烟史、高血压史、糖尿病史、体重指数（body mass index，BMI）等一般资料，比较术前、末次随访时手术上邻近节段FJ的X线、CT、MRI影像学特征（关节间隙狭窄、软骨下骨侵蚀）、邻近节段椎间隙高度、关节突关节角不对称度，依据Weishaupt分级评估FJ退变特征及退变分级，采用秩和检验对两组患者FJ的退变程度进行组内和组间比较。结果：两组患者性别、年龄、随访时间、吸烟史、高血压史、糖尿病史、BMI等一般资料均无统计学差异（P＞0.05）。L4/5组术前关节间隙狭窄、软骨下骨侵蚀的发生率分别为51.9%、38.4%；末次随访时发生率分别为73.1%，67.3%。L4-S1组术前发生率分别为67.3%、34.8%；末次随访时发生率分别为97.8%、60.9%。末次随访时，L4/5组邻近FJ重度退变率为52%，L4-S1组为78.2%。术前L4/5组椎间隙高度、关节突角不对称度分别为8.95±0.38mm、7.79°±0.21°；L4-S1组分别为8.65±0.63mm、7.90°±0.09°；末次随访时，L4/5组分别为8.33°±0.51mm、10.43°±0.33°；L4-S1组分别为7.68±0.53mm、12.06°±0.20°，两组间差异有统计学意义（P＜0.05）。结论：腰椎后路双节段融合固定较单节段更易引起上邻近节段FJ退变，且更容易引起关节突的不对称。

英文摘要:

  【Abstract】 Objectives: To analyze the effect of single or double-level lumbar spinal fusion on the degeneration of the facet joint(FJ) in the adjacent segments, and to discuss the risk factors of the adjacent FJ degeneration. Methods: A retrospective analysis was performed on 49 patients with degenerative lumbar spinal disease undergoing PLIF in our hospital from January 2009 to December 2015, including 27 males and 22 females, with an average age of 55.4±8.6 (41-72) years and follow-up of 33.0±6.6(20-42) months. According to the number of fusion segments, 26 patients were classified into the L4/5 group and 23 patients into the L4-S1 group. Patients′ gender, age, follow-up time, history of smoking, history of hypertension, diabetes, body mass index(BMI), and other general data were collected. Then the incidence of adjacent segment degeneration of intervertebral disc height, facet joint angle asymmetry degree using X-ray, CT and MRI imaging characteristics at preoperation and at final follow-up were compared. The FJ degeneration was assessed according to Weishaupt classification, and the degree of FJ degeneration was compared between two groups by rank sum test. Results: There was no statistical difference in general data such as sex, age, follow-up time, smoking history, hypertension, diabetes or BMI(P>0.05). The rates of joint space stenosis and subchondral bone erosion were 51.9% and 38.4% in L4/5 group before operation, 73.1% and 67.3% respectively at final follow-up. The incidence rates of joint space stenosis and subchondral bone erosion of L4-S1 group were 67.3% and 34.8% preoperatively, and 97.8% and 60.9% at the final follow-up. At the final follow-up, the rate of moderate and severe degeneration in adjacent FJ was 52% in L4/5 group and 78.2% in L4-S1 group, repectively. Before operation, the height of intervertebral space and the degree of asymmetry of facet angle in L4/5 group were 8.95±0.38mm and 7.79°±0.21°; while those in L4-S1 group were 8.65±0.63mm and 7.90°±0.09° respectively. At final follow-up, L4/5 group was 8.33±0.51mm and 10.43°±0.33°, L4-S1 group was 7.68±0.53mm and 12.06°±0.20°(P＜0.05). Conclusions: The multi-level posterior segment fusion fixation is more likely to cause FJ degeneration in the adjacent segment than the single segment fusion. And it is more likely to cause asymmetry of the articular process.