腰椎柔韧性及关节突关节退变程度对腰椎植入物内固定效果的影响☆

背景：许多腰椎退行性疾病患者内固定后影像学显示获得了充分的神经减压和良好的内固定植骨融合，却残留或出现顽固下腰痛，疗效并不满意，因此可能还存在许多其他因素影响着疗效。 目的：分析腰椎柔韧性及关节突关节退变程度对腰椎植入物内固定疗效的影响。 方法：随访120例行腰4，5单节段内固定患者，内固定前测量前屈、后伸位腰椎前凸角度的变化作为腰椎柔韧性指标，测量腰3，4关节突关节角，并进行退变程度分级，内固定前和内固定后1年对患者进行Oswestry评分，计算改善率。分析腰椎柔韧性及关节突关节退变对内固定后症状改善率的影响。 结果与结论：腰椎柔韧性与内固定后症状改善率呈正相关。关节突关节退变严重组症状改善率差，关节突关节角不对称组症状改善率较差。因此腰椎柔韧性、关节突关节角对称性和关节突关节退变程度是影响腰椎内固定后疗效的重要因素。

Effect of the lumbar flexibility and facet joint degeneration on the improvement rate after lumbar internal fixation

BACKGROUND: Imaging shows that many patients with lumbar degenerative disease after internal fixation obtain sufficient neurological decompression and good bone graft fusion, but they can not satisfy with clinical effect because of residual low back pain, so there may exist other factor which affect the clinical effect. OBJECTIVE: To investigate the effect of the lumbar flexibility and facet joint degeneration on clinical effect of lumbar internal fixation. METHODS: Totally 120 cases underwent lumbar internal fixation of L4 and L5. Lumbar lordosis angle at extension and flexion position was measured preoperatively as the lumbar flexibility index. Facet joint angle of L3,4 was measured and the degeneration of facet joint was graded. Oswestry score was obtained before and after one year operation and improvement rate was calculated. The effect of the lumbar flexibility and facet joint degeneration on the improvement rate after operation was analyzed. RESULTS AND CONCLUSION: Lumbar flexibility was positively correlated with the improvement rate. Patients with severe degeneration of the facet joint and with asymmetry facet joint angle both have a bad improvement rate. Lumbar flexibility, lumbar facet joint degeneration and facet joint symmetry are the important factors which influence the outcome of lumbar internal fixation.