脊柱-骨盆矢状位参数与关节突矢状化对腰椎融合术后近端邻近关节突退变的影响  

Effect of spine-pelvis sagittal parameters and sagittal orientation of facet joint on degeneration of cranial adjacent facet joint after posterior lumbar interbody fusion

作　　者：薛鹏飞 金胡日查[1] 徐冠华[1] 保国峰[1] 陈黎敏[1] 崔志明[1] Xue Pengfei;Jinhu Richa;Xu Guanhua;Bao Guofeng;Chen Limin;Cui Zhiming(Department of Spine Surgery,the Second Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学第二附属医院脊柱外科,南通226001

出　　处：《中华骨科杂志》2022年第22期1506-1513,共8页Chinese Journal of Orthopaedics

基　　金：南通市市级科技计划指导性项目(JCZ20126);南通市市级科技计划指导性项目(JCZ19024);南通市2020社会民生科技公共健康面上项目(MS12020012)。

摘　　要：目的分析脊柱-骨盆矢状位参数与关节突矢状化对L_(4)~S_(1)融合术后近端邻近节段(L3,4)关节突关节退变(facet joint degeneration,FJD)的影响。方法纳入2012年1月至2016年12月因腰椎退行性疾病行L4~S1后路腰椎椎间植骨融合术患者共54例,男28例、女26例;年龄(54.59±5.48)岁(范围45~60岁)。应用X线、CT、MRI及Weishuapt分级评估近端邻近节段L3,4关节突有无退变并进行分组,比较两组患者一般资料及末次随访时脊柱-骨盆矢状位参数,包括年龄、性别、体质指数(body mass index,BMI)、骨密度(bone mineral density,BMD)、随访时间、术前诊断、下腰椎前凸角(lower lumbar lordosis,LLL)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、椎间隙高度(height of disk,HD)及近端关节突关节角。比较术前及随访时的Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)腰椎功能评分及改善率。应用二元logistic回归分析筛选邻近节段FJD的危险因素。结果随访时间(33.44±6.85)个月(范围24~36个月),关节突退变组17例,关节突非退变组37例;两组患者年龄、性别、BMI、BMD、随访时间、术前诊断、术后LLL、LL、SS的差异均无统计学意义。末次随访时关节突退变组PI为56.28°±6.03°、PT为17.90°±7.06°,大于关节突非退变组的47.87°±8.30°、14.41°±5.51°,两组差异有统计学意义(P<0.05);关节突退变组近端关节突关节角为58.48°±2.00°,关节突非退变组为54.69°±3.01°,两组差异无统计学意义(P>0.05);关节突退变组HD为(7.50±3.60)mm,关节突非退变组为(9.30±2.79)mm,两组差异有统计学意义(t=2.00,P=0.031)。按下腰椎前凸分布指数是否异常进行分层分析,差异有统计学意义(χ2=9.90,P=0.006)。Logistic回归分析显示PI增大(OR=1.22,P=0.005)及近端关节突关节角增大(OR=2.04,P=0.Objective To analyze the effect of spine-pelvis sagittal parameters and sagittal orientation of facet joint on degeneration of cranial L3,4 facet joint(facet joint degeneration,FJD)after L4-S1 posterior lumbar interbody fusion(PLIF).Methods Patients with lumbar degenerative diseases who underwent L4-S1 PLIF from January 2012 to December 2016 were retrospectively investigated,there were 54 cases,including 28 males and 26 females.Age:54.59±5.48 years(range,45-60 years).X-ray,CT,MRI and Weishuapt grade was used to evaluate the degeneration of L3,4 facet joint at the cranial adjacent segment.The general information and the sagittal parameters of spine pelvis at the last follow-up were compared between the two groups.The former included age,gender,body mass index(BMI),bone mineral density(BMD),follow-up time and preoperative diagnosis.The latter included lower lumbar lordosis angle(LLL),lumbar lordosis angle(LL),pelvis incidence(PI),pelvis tilt(PT),sacrum slope(SS),the height of the intervertebral space(HD),the angle of cranial facet joint,Oswestry disability index(ODI),Japanese Orthopedic Association(JOA)lumbar function score and improvement rate were compared at the same time.Independent sample t-test was used to compare continuous variables between groups;comparison of categorical variable componentsχ2 test or Fisher's exact test.Multivariate logistic regression analysis was used to predict the risk factors of adjacent FJD.Results Postoperative follow-up was 33.44±6.85 months(range,24-36 months),there were 17 patients in the degenerative group and 37 patients in the non degenerative group.There were no significant differences in age,gender,BMI,BMD,follow-up time or preoperative diagnosis between the two groups.LLL,LL and SS also showed no significant difference.At the last follow-up,PI(56.28°±6.03°vs.47.87°±8.30°,t=3.74,P=0.001),PT(17.90°±7.06°vs.14.41°±5.51°,t=1.97,P=0.042)and the joint angle of the cephalic facet(58.48°±2.00°vs.54.69°±3.01°,t=4.72,P=0.072)in the degenerative group were greate

关 键 词：腰椎 脊柱融合术 手术后并发症 椎间盘退行性变 椎关节突关节 危险因素 

分 类 号：R687.3[医药卫生—骨科学]