腰椎经皮椎弓根置钉中小关节角与关节突关节破坏的相关性研究

摘要

目的 探讨腰椎经皮椎弓根置钉术中小关节角对关节突关节破坏的影响及相关性.方法 回顾性分析2013年12月至2016年11月采用腰椎经皮椎弓根螺钉置钉治疗115例腰椎骨折或退行性疾病患者的病例资料,男56例,女59例;年龄15～77岁,平均(53.71±12.19)岁.测量腰椎节段和椎弓根平面上的小关节角(facet angle,FA),并对术后关节突关节破坏进行诊断及分级.双因素方差分析上腰椎组、下腰椎组及L1～L5节段不同FA对关节突关节破坏率的影响,评价FA与关节突关节破坏和破坏分级之间的相关性.结果 上腰椎组和下腰椎组患者年龄、性别、体重指数的差异均无统计学意义.经皮椎弓根螺钉置钉476枚,其中L1为144枚,L2为136枚,L3为64枚,L4为72枚,L5为60枚.共145枚(30.46％)存在关节突关节破坏.其中,上腰椎组344枚(72.27％),关节突关节破坏率为28.78％ (99/344);下腰椎组132枚(27.73％),关节突关节破坏率为34.85％(46/132),两组关节突关节破坏率比较差异无统计学意义(x2=1.66,P=0.20).双因素方差分析结果显示当FA＞ 35°时,关节突关节破坏率明显增加(F=20.12,P＜ 0.001),L1～L5不同腰椎节段对关节突关节破坏率的影响并不显著(F=0.93,P=0.45).FA与关节突关节破坏率之间行Spearman秩相关分析,结果显示两者存在相关性(r=0.25,P＜ 0.001).FA与关节突关节的破坏等级进行Spearman秩相关分析,结果显示两者存在相关性(r=0.27,P＜0.001).结论 传统“C”型臂X线机透视下的经皮椎弓根置钉技术存在较高的关节突关节破坏率,椎弓根平面上小关节角大小明显影响关节突关节破坏发生率和严重程度.%Objective To investigate the relationship between the facet angle (FA) and facet violation in percutaneous pedicle screw placement in lumbar vertebrae.Methods From December 2013 to November 2016,atotal of 115 lumbar fracture or degenerative disease patients who had undertaken percutaneous pedicle screw operation was retrospectively analyzed.There were 56 males and 59 females,with an average age of 53.71±12.19 years (ranged from 15 to 77 years).Measure the FA at the level of pedicle through CT scan,diagnosis and evaluate the grade of facet joint violation after the operation.Analyzed the effect of variant FA and lumbar segment (L-L5) on the facet violation (FV) with two-way analysis of variance,and evaluate the correlation between the FA and FV in percutaneous pedicle screw placement.Results There was no significant difference between the two groups on age,gender,and body mass index.476 percutaneous pedicle screws were operated in this study:L1 144 screws,L2 136 screws,L3 64 screws,L,72 screws and L5 60 screws.The total FV rate was 30.46％ (145/476).344 screws in the upper lumbar group,and the FV rate was 28.78％ (99/344);132 screws in lower lumbar group,and the FV rate was 34.85％ (46/132).There was no significant difference of FV rate between the two groups (x2=1.66,P=0.20).The result of two-way analysis of variance indicated that the FV rate increased dramatically when FA ＞ 35° (F=20.12,P ＜ 0.001),but FV rate was not related to the lumbar segment statistically (F=0.93,P=0.45).Spearman rank correlation analysis was performed between FA and FV rate,FV grade.The result was both positive (r=0.25,P ＜ 0.001 and r=0.27,P ＜ 0.001).Conclusion The traditional C-arm fluoroscopy percutaneous pedicle screw placement technique has a high rate of FV,and the size of FA significantly affects the incidence and severity of FV.