MIS-TLIF术中上位关节突关节侵扰的危险因素

Risk factors of upper zygapophyseal joints intrusion during MIS-TLIF

目的 探讨微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF)术中上位关节突关节侵扰的危险因素。方法 选择2018年2月-2020年2月本院采用MIS-TLIF术治疗的165例腰椎退行性疾病患者,CT评价椎弓根螺钉对关节突关节的侵扰程度,并根据是否发生上位关节突关节侵扰设为侵扰组与未侵扰组,采用多因素Logistic回归分析调查MIS-TLIF术中上位关节突关节侵扰的危险因素。结果 165例中,48例发生上位关节突关节侵扰,发生率29.09%;侵扰组与未侵扰组的手术节段、顶椎置钉位置、体质量指数(body mass index, BMI)、关节突关节退变分级、螺钉内倾角度差异具有统计学意义(P<0.05),两组年龄、性别、连接棒形状、疾病类型差异无统计学意义(P>0.05);多因素Logistic回归分析显示,顶椎置钉为L、BMI>28 kg/m^(2)、关节突关节3级退变是MIS-TLIF术中上位关节突关节侵扰的独立危险因素。结论 MIS-TLIF术中置钉容易侵扰上位关节突关节,顶椎置钉为L、肥胖以及关节突关节退变程度较高者,更易发生上位关节突关节侵扰。

Objective To discuss the risk factors of upper zygapophyseal joints intrusion during minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF). Methods A total of 165 patients with degenerative lumbar disease who admitted to our hospital from February 2018 to February 2020 were selected and treated with MIS-TLIF. CT was used to evaluate the degree of pedicle screw intrusion into the facet joint. According to whether the upper joint had protrusive joint intrusion, they were divided into the intrusive group and the non-intrusive group. Multi-factor Logistic regression analysis was used to investigate the risk factors for joint infestation of upper zygapophyseal joints. Results Of the 165 patients with degenerative lumbar disease, 48 cases had upper articular process joint infestation, the incidence rate was 29.09%. The surgical segment, the position of the apical vertebral nail, body mass index(BMI), the grade of articular process joint degeneration, and the screw inversion angle had statistically significant differences between the two groups(P<0.05), but there were no statistically significant differences in age, gender, connecting rod shape and disease type between the two groups(P>0.05). Multivariate logistic regression analysis showed that the top vertebral nail L, BMI> 28 kg/m^(2), grade 3 degeneration of the facet joint were the independent risk factors for upper facet joint intrusion during MIS-TLIF. Conclusion In the MIS-TLIF operation, the placement of the nail is easy to invade the upper articular process joints. The top vertebral nails L, obese, and those with a high degree of degeneration of the articular process joints are more prone to occur upper articular process joints.