腰椎间盘手术后小关节的完整性与疗效的关系

Integrity of lumbar facet joint and curative effect after a lumbar intenvertebral disc operation

目的:探讨腰椎间盘手术术后小关节保留程度与疗效的关系,为腰椎间盘后路手术术式的合理选择提供依据。方法:选择43例行单节段椎间盘摘除的L4～5椎间盘突出症患者,手术方式有椎板间开窗、半椎板切除及全椎板切除。依据术后双侧小关节的完整性分组,比较分析各组术后2年日本矫形外科学会(JOA)分值。结果:术前JOA评分各组比较差异无统计学意义(P>0.05);术后2年JOA评分与完整组相比,单侧小关节全切组和单侧全切加对侧部分组明显下降(P<0.01);单或双侧小关节部分切除组术后2年JOA评分与完整组相比下降无统计学意义(P>0.05)。结论:完整小关节保留对临床疗效起着重要的作用,后路手术应尽量避免损伤小关节。

Objective To analyze the relation between the clinical outcome and the integrity of the facets after a lumbar operation, and to provide a reference for choosing operative method and clinical prognosis. Methods Forty-three patients with complete data underwent uni-segment discectomy were enrolled. There were 3 surgical interventions： open-window diseeetomy, full or semi-lamineetomy. Groups were divided based on the integrity of the facets after the operation, and the clinical symptoms and signs were evaluated using the Japanese Orthopaedic Association Back （JOA） scores at 24-month follow-up. Results Preoperative JOA scores were not significantly different among the groups （P 〉 0.05 ）, Compared with the facet intact group at 24-month follow-up ,JOA scores were descended statistically in total uni-facetectomy group and total uni-facetectomy plus partial opposite facetectomy group （P〈0. 01 ）. Conclusion achieving good clinical results, and the damage Keeping facets integrated of facet should be avoided plays an important role in in the lumbar operation.