腰椎小关节病变在腰痛中的作用(附516例前瞻性研究)

Pathologic changes of facet joint in chronic low back pain: a prospective study of 516 cases

目的:观察腰椎手术中不同方式处理小关节对腰痛的影响,探讨腰椎小关节病变在腰痛中的作用。方法:对516例退变性腰椎疾病手术患者随机分为两组,每组258例,分别采取不同方式处理腰椎小关节突。其中实验组术中电刀环状烧灼小关节囊,破坏关节面;对照组保留小关节囊。分别于术后6个月、1年和2年观察腰椎活动度,随访腰痛改善情况。结果:两组腰椎活动度无显著差异。实验组腰痛完全消失172例,明显缓解64例,无变化16例,术后腰痛加重6例。对照组腰痛完全消失114例,明显缓解108例,无变化28例,加重8例。两者经统计分析结果有显著差异(x2=26.63,P<0.001)。结论:术中环状烧灼小关节囊,破坏关节面有利于减轻或缓解术后腰痛,进一步证实了腰椎小关节病变与腰痛有明显关系。术后腰痛加重与小关节的处理与否无关。

Objective:To study the role of facet joint in chronic low back pain and to evaluate the effect of resecting the facet joint capsule during lumbar operation. Methods: Five hundred and sixteen patients with degenerative lumbar disease were employed in this study and were evenly divided into 2 groups. Patients in the experimental group received annular cauterization of zygapophysial joint capule using electro-knife and their articular facet was destroyed. The zygapophysial joint capsule of another group remian intact. All patients received a mean of 34 months followup, ranging 6-240 months, and their lumbar motility at 6 months, 1 year, 2 years after operation was observed. Results: In the experimental group, the low back pain disappeared in 172 cases, relieved in 64 cases, remained unchanged in 16 cases and deteriorated in 6 cases; while in the control group, the low back pain disappeared in 114 case, relieved in 108 cases, remained unchanged in 28 cases and deteriorated in 8 cases. There was no singificant difference about the motility of treated segment according to pre- and postoperative x-ray film in 2 groups, but there was significant difference in those who had obtained complete cure of low back pain between 2 groups(x2=26. 63, P<0. 001). Conclusion: Annular cauterization of the facet joint capsule can cure or relieve the lumbago during lumbar operation with no complications. The degenerative change of facet joint is one of the causes of chronic low back pain.