邻近节段关节突关节退变对腰椎融合固定术后邻近节段疾病的影响

Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation

目的:探究邻近节段关节突关节退变对腰椎融合固定术后邻近节段疾病的影响。方法:对2016年6月至2019年6月接受L5S1腰椎后路椎间融合固定术(posterior lumbar interbody fusion,PLIF)的138例患者进行回顾性分析。根据术前L4,5关节突关节是否有退变(采用Weishaupt分级标准)分为退变组68例,无退变组70例。收集两组患者年龄、性别、身体质量指数、随访时间、术前L4,5椎间盘退变情况(采用Pfirrmann分级)等数据,采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能指数(Oswestry disability index,ODI)评估术后1、3个月的临床疗效,分析术后邻近节段疾病(adjacent segment disease,ASD)发生情况以及发生ASD时间。结果:两组患者在年龄、性别、身体质量指数、随访时间、术前L4,5椎间盘退变情况方面比较,差异无统计学意义(P>0.05)。两组患者术后1、3个月VAS及ODI均较术前明显降低(P<0.001),两组间比较差异无统计学意义(P>0.05)。两组术后发生ASD例数与发生ASD时间比较,差异有统计学意义(P<0.05)。在退变组中,Ⅰ级退变发生ASD 2例,Ⅱ级退变发生ASD 4例,Ⅲ级退变发生ASD7例。Ⅲ级退变发生ASD例数与Ⅰ、Ⅱ级差异有统计学意义(Bonferroni校正P<0.0167)。结论:术前邻近节段存在关节突关节退变,腰椎融合固定术后会增加ASD发生,当关节突关节Ⅲ级退变,术后发生ASD风险会进一步加大。

Objective To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease(ASD)after lumbar fusion and fixation.Methods A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion(PLIF)from June 2016 to June 2019.Patients were divided into a degeneration group(68 cases)and a non-degenerative group(70 cases)based on the presence or absence of L4,5 facet joint degeneration before surgery(graded using the Weishaupt standard).Age,gender,body mass index(BMI),follow-up time,and preoperative L4,5 intervertebral disc degeneration(graded using the Pfirrmann standard)were collected for both groups.Clinical outcomes were evaluated using the visual analogue scale(VAS)and Oswestry disability index(ODI)at 1 and 3 months after surgery.The incidence and time of ASD after surgery were analyzed.Results There were no significant differences between the two groups in age,gender,BMI,follow-up time,or preoperative L4,5 intervertebral disc degeneration.Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery(P<0.001),with no significant difference between the groups(P>0.05).However,there was a statistically significant difference in the incidence and timing of ASD between the groups(P<0.05).The degeneration group had 2 cases of ASD in gradeⅠdegeneration,4 cases of ASD in gradeⅡdegeneration,and 7 cases of ASD in gradeⅢdegeneration.There was a statistically significant difference between the number of patients with gradeⅢdegeneration and those with gradesⅠandⅡASD(P<0.0167,Bonferroni correction).Conclusion Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation,whereas gradeⅢdegeneration will further increase the risk.