微创经椎间孔腰椎椎体间融合术对邻近节段侵扰情况及术后影像学退变的影响

doi:10.3969/j.issn.1671-7171.2022.11.025

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摘要【目的】探讨微创经椎间孔腰椎椎体间融合术(MIS-TLIIF)对邻近节段侵扰情况及术后影像学退变(ASDed)的影响。【方法】本院收治的185例行MIS-TLIIF治疗的单节段退行性腰椎病变患者为研究对象。术后3个月,统计患者邻近节段关节突关节侵扰的发生情况,根据患者关节是否侵扰分为侵扰组与非侵扰组。探讨影响MIS-TLIIF术后邻近节段关节突关节侵扰的相关因素;随访3年,比较侵扰组与非侵扰组术后3年内ASDed的发生情况。【结果】术后3个月,邻近节段关节突关节发生侵扰64例,发生率为34.59%;未侵扰组121例。侵扰组体重指数(BMI)≥30 kg/m²,顶椎节段为L₅,术前关节突关节角≥40°例数占比,关节突关节轴径、冠状径、矢状径高于非侵扰组(P<0.05);侵扰组术前螺钉内倾角、螺帽-上关节突间距低于非侵扰组(P<0.05)。Logistic多因素回归分析结果显示,顶椎节段为L₅、BMI≥30 kg/m²、术前关节突关节角≥40°均为MIS-TLIIF术后关节侵扰的影响因素(P<0.05)。随访3年,侵扰组失访2例,非侵扰组失访4例,随访率为96.76%,侵扰组术后3年内ASDed的发生率(56.45%)高于非侵扰组(39.32%)(P<0.05)。【结论】顶椎节段为L₅、BMI≥30 kg/m²、术前关节突关节角≥40°均为MIS-TLIIF术后邻近节段关节突关节侵扰的影响因素,且术后邻近节段关节突关节侵扰的患者术后3年内ASDed的发生风险较高。

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关键词 ：脊柱融合术/方法, 腰椎/外科学, 腰椎/影像诊断, 最小侵入性外科手术

Abstract：【Objective】To investigate the effects of in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIIF) on the intrusion of adjacent segments and postoperative imaging degeneration of adjacent segments disorder (ASDed). 【Methods】A total of 185 patients with single-segment degenerative lumbar spine disease treated with MIS-TLIIF in our hospital were enrolled in the syudy.Three months after surgery,the incidence of intrusion of the adjacent joint facet joints was counted.Patients were divided into the intrusive group and the non-intrusive group according to whether the adjacent segmental facet joints were invaded.The related factors affecting the intrusion of adjacent segmental facet joints after MIS-TLIIF were analyzed.After 3 years of follow-up,the incidence of ASDed after the operation was compared between the intrusive group and the non-intrusive group. 【Results】Three months after surgery,64 cases of adjacent segmental facet joint intrusion occurred,the incidence was 34.59%,while 121 cases were not disturbed.In the intrusion group,body mass index (BMI) ≥30 kg/m²,apical vertebral segment of L₅,preoperative facet joint angle ≥40°,facet joint axial diameter,coronal diameter and sagittal of the shape diameter were higher than those of the non-intrusive group (P＜0.05).The preoperative screw inclination angle and the distance between nut and superior articular process in the intrusion group were lower than those in the non-intrusion group (P＜0.05). Logistic multivariate regression analysis showed that the apical vertebral segment of L₅,BMI≥30 kg/m²,and preoperative facet joint angle ≥40° were all influencing factors for the intrusion of the adjacent segmental facet joint after MIS-TLIIF (P＜0.05).After 3 years of follow-up,2 cases in the intrusion group and 4 cases in the non-intrusion group were lost to folloe-up.The follow-up rate was 96.76%.The incidence of ASDed in the intrusion group (56.45%) was higher than that in the non-intrusion group (39.32%,P<0.05). 【Conclusion】The apical vertebral segment of L₅,BMI≥30 kg/m² and preoperative facet joint angle ≥40° are the influencing factors of the adjacent segmental facet joint invasion after MIS-TLIIF.And Patients with the adjacent segmental facet joint invasion after MIS-TLIIF have a higher risk of ASDed within 3 years after surgery.

Key words： Spinal Fusion/MT Lumbar Vertebrae/SU Lumbar Vertebrae/DG Minimally Invasive Surgical Procedures

收稿日期: 2022-02-14

中图分类号:

R681.533.1

通讯作者: *E-mail:373108203@qq.com

引用本文:

陈志辉, 孙鹏程, 王国柱, 倪虹, 刘阿敏, 张宝英. 微创经椎间孔腰椎椎体间融合术对邻近节段侵扰情况及术后影像学退变的影响[J]. 医学临床研究, 2022, 39(11): 1687-1690.
CHEN Zhi-hui, SUN Peng-cheng, WANG Guo-zhu, et al. Effect of Minimally Invasive Transforaminal Lumbar Interbody Fusion on Adjacent Segment Intrusion and Postoperative Imaging Degeneration of Adjacent Segment Disorder. JOURNAL OF CLINICAL RESEARCH, 2022, 39(11): 1687-1690.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.11.025 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I11/1687

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