Xu Zhengkuan, Tao Yiqing, Li Hao, Chen Gang, Li Fangcai, Chen Qixin
Department of Orthopedics, 2nd Affiliated Hospital, School of medicine, Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2018 Jun;97(22):e10943. doi: 10.1097/MD.0000000000010943.
This is a retrospective study of case records. The aim of this study was to investigate the relationship between the facet angle (FA) at the pedicle level and facet joint violation (FJV) in percutaneous pedicle screw fixation (PPSF) in lumbar vertebrae.Current PPSF technique has a high facet violation rate than open surgery, and the relationship of FJV and FA has not been studied.Retrospective imaging analysis was conducted for 115 cases who underwent PPSF from December 2013 to November 2016 by the same group of surgeons using the same technique, in the spine surgery center of our hospital. The FA at the pedicle level was measured by computed tomography, and diagnosis and evaluation of FJV grade were performed postoperatively. The effect of the variant FA and lumbar segment (L1-L5) on FJV, and the correlation between FA and the FJV and FJV grade in PPSF were evaluated.A total of 476 percutaneous pedicle screws were included: 144 L1, 136 L2, 64 L3, 72 L4, and 60 L5 screws, with a total FJV rate of 30.46% (145/476). The FJV rate was 28.78% in upper lumbar group with 344 screws (99/344), and 34.85% in lower lumbar group with 132 screws (46/132). There was no significant difference between groups with regards to FJV rate, and age, sex, or BMI index. Evaluation of variant FA and lumbar segment on FJV rate indicated that FJV rate increased dramatically when FA >35 degree; however, FJV rate was not significantly related to the lumbar segment. There was a positive correlation between FA and FJV rate, as well as FA and FJV grade.There was a positive correlation between the increase of the FA at the pedicle level, and the FJV rate and FJV grade. The FJV risk increased remarkably when the FA was >35 degree.
这是一项对病例记录的回顾性研究。本研究的目的是调查腰椎经皮椎弓根螺钉固定术（PPSF）中椎弓根水平的小关节角（FA）与小关节侵犯（FJV）之间的关系。当前的PPSF技术比开放手术有更高的小关节侵犯率，且FJV与FA之间的关系尚未得到研究。对2013年12月至2016年11月在我院脊柱外科中心由同一组外科医生使用相同技术进行PPSF的115例患者进行回顾性影像学分析。通过计算机断层扫描测量椎弓根水平的FA，并在术后对FJV分级进行诊断和评估。评估变异FA和腰椎节段（L1-L5）对FJV的影响，以及PPSF中FA与FJV及FJV分级之间的相关性。共纳入476枚经皮椎弓根螺钉：144枚L1螺钉、136枚L2螺钉、64枚L3螺钉、72枚L4螺钉和60枚L5螺钉，总FJV率为30.46%（145/476）。上腰椎组344枚螺钉的FJV率为28.78%（99/344），下腰椎组132枚螺钉的FJV率为34.85%（46/132）。两组在FJV率、年龄、性别或BMI指数方面无显著差异。对变异FA和腰椎节段对FJV率的评估表明，当FA>35度时，FJV率显著增加；然而，FJV率与腰椎节段无显著相关性。FA与FJV率以及FA与FJV分级之间存在正相关。椎弓根水平FA的增加与FJV率和FJV分级之间存在正相关。当FA>35度时，FJV风险显著增加。
