关节突关节不对称对腰椎后路椎间融合术治疗退行性腰椎滑脱临床疗效的影响  

The effect of facet tropism on the clinical efficacy of posterior lumbar intervertebral fusion(PLIF)surgery in the treatment of degenerative spondylolisthesis

作　　者：于浩 阚顺利 胡炜[1] 朱如森[1] YU Hao;KAN Shun-li;HU Wei;ZHU Ru-sen(Department of Spine Surgery,Tianjin Union Medical Center,Tianjin 300122,China)

机构地区：[1]天津市人民医院脊柱外科,天津300122

出　　处：《实用医院临床杂志》2024年第3期14-19,共6页Practical Journal of Clinical Medicine

基　　金：天津市卫健委中西医结合重点项目(编号:2023057)。

摘　　要：目的探讨关节突关节不对称(FT)对腰椎后路椎间融合术(PLIF)改善退行性腰椎滑脱脊柱参数和临床症状的影响。方法回顾性分析2016年1月至2020年12月在我院接受PLIF手术治疗的退行性腰椎滑脱患者76例,以双侧关节突关节角差值超过10°分为对照组与FT组各38例;对比两组手术前后的临床资料变化,影像参数评估包括滑脱率、椎间隙高度、腰椎前凸角、骶骨倾斜角、骨盆倾斜角、Cobb角和腰椎活动度,临床症状评估包括疼痛视觉模拟评分、Oswestry功能障碍指数和MacNab分级;分析影像学参数与临床症状的相关性,并根据术前FT的不同节段进行分组,比较各组与对照组之间的影像学参数和症状评分变化。结果平均随访时间23.63个月,FT组的腰椎活动度低于对照组(P<0.05),其余术前临床资料比较差异无统计学意义(P>0.05);手术治疗后两组的影像学参数和症状评分均较术前有所好转,FT组的术后腰椎前凸和腰椎活动度低于对照组(P<0.01);FT组随访时的VAS评分和ODI评分显著高于对照组(P<0.01);Pearson相关性分析显示,骨脱率(SP)、椎间隙高度(IH)、腰椎前凸角(LL)、骶骨倾斜角(SS)和关节活动度(ROM)的矫正与两组患者的VAS改善和ODI改善均呈显著相关(P<0.05),手术节段FT和多节段FT的腰椎前凸矫正程度显著低于对照组(P<0.05)。结论采用PLIF手术治疗退行性腰椎滑脱能够恢复患者腰椎生理曲度,获得良好的症状改善,但患者术后出现腰椎活动受限。FT阻碍了腰椎形态的矫正,是PLIF手术疗效欠佳的重要原因。Objective To explore the effect of facet tropism(FT)on improving spinal parameters and clinical symptoms of degenerative lumbar spondylolisthesis(DLS)after posterior lumbar intervertebral fusion(PLIF)surgery.Methods Seventy-six DLS patients who received PLIF surgery in our hospital from January 2016 to December 2020 were retrospectively analyzed.The patients were divided into a non-facet tropism(NFT)group and a facet tropism(FT)group according to the difference of bilateral facet joint angles of more than 10°,38 in each group.The changes of clinical data before and after operation were compared between the two groups.The evaluation of imaging parameters included slippage percentage(SP),intervertebral height(IH),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),Cobb angle and range of motion(ROM)in lumbar spine.The evaluation of clinical symptoms in-cluded Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and MacNab classification.The correlation between the imaging parameters and symptom scores was assessed.The patients were also grouped according to different segments of preoperative FT,and the changes of imaging parameters and symptom scores were compared between each group and the control group.Results The average follow-up time was 23.63 months.The ROM in the FT group was lower than that in the NFT group(P<0.05)while other preoperative clinical data were similar(P>0.05).The imaging parameters and clinical symptom scores of the two groups after PLIF surgery were improved when compared with those before surgery.The postoperative LL and ROM in the FT group were lower than those in the NFT group(P<0.01).The VAS score and ODI score of the FT group at follow-up were significantly higher than those of the control group(P<0.01).Pearson correlation analysis showed that the correction of SP,IH,LL,SS and ROM was significantly related to the improvement of VAS and ODI in both groups(P<0.05).The degree of LL correction in surgical segmental FT and multi-segment FT was significantly lower than that in the contro

关 键 词：关节突关节不对称 退行性腰椎滑脱 腰椎融合术 腰椎影像参数 

分 类 号：R681.5[医药卫生—骨科学]