严重关节突退变对猫眼侧方入路腰椎椎体间融合术间接减压效果的影响  

Radiographic and clinical outcome of crenel lumbar interbody fusion for lumbar spinal stenosis with severe facet joint arthropathy

作　　者：李君[1] 李方财[1] 陈其昕[1] 陈刚[1] 张宁[1] 徐正宽[1] 李浩[1] 王智伟 徐天臻 Li Jun;Li Fangcai;Chen Qixin;Chen Gang;Zhang Ning;Xu Zhengkuan;Li Hao;Wang Zhiwei;Xu Tianzhen(Departmenr of Orthopaedics,The Second Affiliated Hospital of Medical College Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2022年第1期1-8,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81702225);浙江省医药卫生重大科技计划(WKJ-ZJ-1903)。

摘　　要：目的探讨不同程度关节突退变对猫眼侧方入路腰椎椎体间融合术(crenel lateral interbody fusion,CLIF)的间接减压效果的影响,以及CLIF治疗伴严重关节突退变(3级)腰椎管狭窄症患者的临床疗效。方法回顾性收集2016年11月至2020年2月应用CLIF技术治疗腰椎管狭窄症患者156例共269个手术节段。根据术前CT影像,按照Pathria分级对关节突进行分级,0级19个节段、1级156个节段、2级67个节段、3级27个节段,至少1个节段关节突为3级的患者共23例。影像学评估指标包括椎间隙角度、椎间隙前后缘高度、双侧椎间孔纵径(CT)、椎管前后径和椎管面积(MRI)。临床疗效评价采用视觉模拟疼痛评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)。结果3级关节突退变节段术后的平均椎间隙前后缘高度、椎间隙角度,双侧椎间孔纵径、椎管前后径和椎管面积均得到明显改善。3级关节突退变节段的术前平均椎管前后径和椎管面积明显小于1级和2级。术后3级关节突退变节段椎管面积的改变值明显小于1级和2级关节突退变节段,但与0级关节突退变节段的差异无统计学意义。3级关节突退变节段的二期后路减压率为55.56%(15/27),2级为35.82%(24/67),1级为16.03%(25/156),0级为21.05%(4/19)。3级关节突退变的后路减压率明显高于其他等级(P<0.001)。81.48%的3级关节突退变节段合并严重侧隐窝狭窄,24.24%合并严重椎间孔狭窄。23例患者随访时间为(21.62±6.52)个月,末次随访时ODI平均改善值为24.10%±11.09%,平均腰痛和下肢痛VAS评分均得到明显改善。结论关节突关节的退变程度对CLIF撑开椎间隙和椎间孔的作用无明显影响,但严重关节突退变的腰椎节段常合并严重的椎管狭窄,CLIF手术的间接减压效果差于退变程度较轻的节段,可能需要通过后路直接减压才能达到更好的临床疗效。Objective To investigate the influence of different degrees of facet joint arthropathy on the indirect decompression effect of crenel lumbar interbody fusion(CLIF),and the clinical outcomes of CLIF for the treatment of lumbar spinal stenosis with severe facet joint arthropathy(grade 3).Methods This study reviewed a total of 269 surgical segments in 156 patients with lumbar spinal stenosis treated with CLIF technique from November 2016 to February 2020.According to preoperative CT images,the facet joint was graded according to Pathria classification.There are 19 segments with grade 0,156 segments with grade 1,67 segments with grade 2,and 27 segments with grade 3.Radiographic parameters included disc angle,anterior and posterior disc height,and bilateral intervertebral foramen height on CT,and the midsagittal canal diameter and axial central canal area.In 30 patients with at least one segment of grade 3,the clinical efficacy was assessed using visual analogue scale(VAS)and Oswestry disability index(ODI).Results The average the anterior and posterior intervertebral space height,intervertebral space angle,height of bilateral intervertebral foramina,spinal canal sagittal diameter and spinal canal area were significantly improved after the operation of grade 3 facet joint degeneration segment compared to preoperation.The preoperative mean spinal canal sagittal diameter and spinal canal area of grade 3 facet joint degeneration segment were significantly less than grade 1 and grade 2.The average change of spinal canal area after grade 3 articular degeneration was significantly less than that of grade 1 and 2,but there was no significant difference with that of grade 0.The posterior decompression rate was 55.56%(15/27)for grade 3,35.82%(24/67)for grade 2,16.03%(25/156)for grade 1,and 21.05%(4/19)for grade 0.The posterior decompression rate of grade 3 articular process degeneration was significantly higher than that of other grades(P<0.001).Severe lateral recess stenosis and 24.24%of severe intervertebral foraminal stenosi

关 键 词：腰椎 椎管狭窄 椎关节突关节 减压术 外科 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]