腰椎小关节囊切除治疗慢性腰痛的前瞻性研究

A prospective study of resection of the facet joint capsule in treatment of the chronic low back pain

目的: 研究腰椎小关节在退变性腰椎疾患中的病理演变和致病机理; 观察小关节囊切除对腰痛的影响。方法: 将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。分别于术后观察腰椎活动度, 随访腰痛改善情况。结果: 两组腰椎活动度无显著差异(P>0 .05)。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。两者有显著差异(P<0. 05)。结论: 腰痛与腰椎小关节病变有明显关系, 术中切除小关节囊有利于减轻或缓解术后腰痛。

Objective:To study the pathogenic role of facet joint in chronic low back pain and its pathologic change in degenerative lumbar disease.To evaluate the effect of resection the facet joint capsule during lumbar operation.Method:516 cases of degenerative lumbar disease were employed in this study and were divided to two groups.Each group,258 cases,received the same therapy to treat the lumbar intervertebral disc,but their facet joint received different treatment.The cases of the test group were experienced resection of facet joint capsule using electro-knife and the cases of the other one remain intact.All cases were received 6 months to 240 months,mean 34 months,followed-up and observed after operation.The pre-and post-operative symptoms of back pain and the move radian of the operated segment of each patient were valued.Result:In the test group,the low back pain was eradicated away in 172 cases,relief in 64 cases,no change in 16 cases and deterioration in 6 cases.While in the contrast group,the low back pain eradicate away in 114 cases,relief in 108 cases,no change in 28 cases and deterioration in 8 cases.There is no significant difference between two groups about the move radian of treated segment according to pre-and post-operative X-ray film ( P>0.05 ).But there is significant difference of the cases who had obtained complete cured of low back pain between two groups( P<0.05 ).Conclusion:The degenerative change of facet joint is one of the main cause of chronic low back pain.Resection of the facet joint capsule can eradicate away or relief the lumbago among partial patients during lumbar operation and no complications were found about this therapy.