腰椎管狭窄症内镜小关节切除范围对预后的影响  

Impact of endoscopic facet joint resection extent on prognosis for lumbar spinal stenosis

作　　者：蒋海军[1] 卜献忠 岑定善 黄剑峰[1] 尹保和 眭金辉 何水文 钟远鸣[3] JIANG Hai-jun;BU Xian-zhong;CEN Ding-shan;HUANG Jian-feng;YIN Bao-he;SUI Jin-hui;HE Shui-wen;ZHONG Yuan-ming(Department of Spinal Surgery and Orthopaedics,Hezhou City Hospital of Traditional Chinese Medicine,Guangxi University of Chinese Medicine,Hezhou,Guangxi 542899,China;Department of Orthopaedics,The First Affiliated Hospital,Henan University of Chinese Medicine,Zhengzhou,Henan 450000,China;Department of Spinal Surgery,The First Affiliated Hospital,Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530012,China)

机构地区：[1]广西中医药大学附属贺州市中医医院脊柱骨科,广西贺州542899 [2]河南中医药大学第一附属医院骨一科,河南郑州450000 [3]广西中医药大学第一附属医院脊柱骨科,广西南宁530012

出　　处：《中国矫形外科杂志》2025年第2期97-103,共7页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:82260942);广西壮族自治区卫健委科研课题(编号:Z-J20221799);贺州市科学研究与技术开发计划项目(编号:贺科技2022114);河南省中医药科学研究专项课题(编号:2023ZXZX1003);广西壮族自治区中管局课题(编号:GXZYZ20210203)。

摘　　要：[目的]探讨在脊柱内镜下行腰椎管减压术时腰椎小关节(lumbar facet joint,FJ)的切除程度与术后临床疗效及腰椎稳定性的关系。[方法]回顾性分析本院2019年1月—2023年10月87例腰椎管狭窄症(lumbar spinal stenosis,LSS)内镜减压患者的临床资料。按术后CT测量FJ的切除量,将之分为4组:极少组(FJ切除量0~25%)22例;较少组(FJ切除量26%~50%)22例;中量组(FJ切除量51%~75%)21例;多量组(FJ切除量76%~100%)22例。比较四组患者围手术期、随访、影像资料。[结果]四组患者手术时间、切口长度、术中出血量、术中透视次数、下地行走时间、住院天数、不良事件发生率的差异均无统计学意义(P>0.05)。所有患者均获得12个月以上的随访,极少量组和少量组恢复完全负重活动的时间显著早于中量组和多量组[(87.8±4.3)d vs(88.6±8.0)d vs(94.6±7.3)d vs(94.3±8.8)d,P=0.002]。随时间推移,各组患者腰部、腿部VAS评分、ODI评分、JOA评分均显著改善(P<0.05)。术后1个月时,极少组和少量组腰痛VAS[(1.9±0.8)vs(2.0±0.5)vs(2.8±0.7)vs(2.9±0.8),P<0.001]、ODI[(27.4±3.5)vs(28.3±1.8)vs(30.1±3.2)vs(30.6±3.2),P=0.002]、JOA评分[(25.1±1.3)vs(25.1±1.1)vs(23.1±1.6)vs(23.3±1.6),P<0.001]显著优于中量组和多量组。影像方面,与术前相比,术后各组椎管面积均显著增加(P<0.05),但是,中量组和多量组腰椎角位移显著增加(P<0.05)。末次随访时,极少组和少量组的角位移显著优于中量组和多量组[(7.6±2.2)°vs(9.4±3.4)°vs(10.4±2.2)°vs(10.6±2.3)°,P<0.001]。[结论]对LSS内镜下FJ的切除量越多术后1年内影像的角移位越大,FJ切除的程度与术后短期内患者腰部疼痛症状及腰椎功能的恢复存在一定的关联,手术减压范围尽量小于FJ的50%。[Objective]To search the relationship between the resection extent of the lumbar facet joint(FJ)and the postoperative clini⁃cal outcome and the lumbar stability after endoscopic lumbar decompression.[Methods]A retrospective research was conducted on 87 pa⁃tients who received endoscopic decompression for lumbar spinal stenosis(LSS)in our hospital from January 2019 to October 2023.Based on the FJ resection extent measured by CT after operation,the patients were divided into four groups,including 22 patients in the minimal group with 0~25%FJ resected,22 patients in the small group with 26%~50%FJ resected,21 cases in the medium group with 51%~75%FJ resected,and 22 patients in the vast group with 76%~100%FJ resected.The perioperative,follow-up and imaging data of the 4 groups were compared.[Results]There were no significant differences in operation time,incision length,intraoperative blood loss,intraoperative fluoroscopy times,postoperative walking time,hospital stay and incidence of adverse events among the 4 groups(P>0.05).All patients in the 4 groups were followed up for more than 12 months,and the minimal and small groups resumed full weight-bearing activities signifi⁃cantly earlier than the medium and vast groups[(87.8±4.3)days vs(88.6±8.0)days vs(94.6±7.3)days vs(94.3±8.8)days,P=0.002].As time went on,the VAS scores for low back pain and leg pain,as well as ODI and JOA scores were significantly improved in all of the 4 groups(P<0.05).One month after surgery,the minimal and small groups proved significantly superior to the medium and vast groups in terms of low back pain VAS[(1.9±0.8)vs(2.0±0.5)vs(2.8±0.7)vs(2.9±0.8),P<0.001],ODI[(27.4±3.5)vs(28.3±1.8)vs(30.1±3.2)vs(30.6±3.2),P=0.002],and JOA score[(25.1±1.3)vs(25.1±1.1)vs(23.1±1.6)vs(23.3±1.6),P<0.001].As for imaging,the spinal canal area was significant⁃ly increased in all the 4 groups after surgery compared with that before surgery(P<0.05),but the lumbar angular displacement was only sig⁃nificantly increased in the medium and vast gro

关 键 词：脊柱内镜 腰椎管狭窄症 小关节切除程度 腰椎稳定性 疗效 

分 类 号：R687[医药卫生—骨科学]