退行性变腰椎滑脱及腰椎间盘突出症患者的放射学评价

Radiologic assessment of the patients with degenerative spondylolisthesis and lumbar disc herniation

目的:观察退行性变腰椎滑脱和椎间盘突出患者关节突关节和椎板的结构变异,以揭示腰椎骨、关节及神经等结构的发育异常或先天性缺陷与下腰痛发生的潜在关系。方法:36例平均年龄39岁腰椎间盘突出症患者,35例平均年龄55岁退行性变腰椎滑脱患者及26例正常人摄制X射线正位片,CT扫描测量关节突和椎板形态(L4～5)。根据下关节突外间距是否比椎弓峡部间距宽和能否显示关节突关节间隙分为X(X1,X2,X3)型和W型,X1型和X2型下关节突均向侧方伸展,但X1型不显示关节间隙,X3型能见到一侧关节间隙。W型下关节突收窄,两侧关节间隙都能显示。结果:W型的关节突矢状排列,在正常组中少见(6.89%),退行性变腰椎滑脱组占多数(45.71%)。X1型关节突冠状排列,在对照组(55.17%)和椎间盘突出组(58.33%)中占多数。W型的椎管大多数为三叶形并伴有侧隐窝狭窄,这可能与滑脱和骨关节炎有关。结论:结果提示W型是发生退行性变腰椎滑脱和椎管狭窄的潜在因素。

AIM: To observe the structural variation of zygapophysial joints and lamina of vertebra in patients with degenerative spondylolisthesis(DS) and lumbar disc herniation(LDH), and reveal the potential relationships between the abnormal development of structures or the congenital defect of lumbar vertebra bone, joint and nerves and the occurrence of low back pain. METHODS:Thirty six patients with LDH averagely aged 39 years,35 patients with DS averagely aged 55 years and 29 normal subjects(NS) were studied.The entopic sheet of X ray was made,and the morphology of articular process and lamina of vertebra(L4-5) were detected by CT.According to whether the spacing of the inferior articular processes was wider than the ischmic part of neural arch or not and the joint space of articular process was showed or not,the configuration of laminas were classified into type X(X1,X2,X3) and type W.The inferior articular processes in types X1 and X2 were extended laterally,but the joint spaces were not observed in type X1.One side articular space could be observed in type X3.The inferior articular process was narrowed in type W,and pbilateral articular processes were observed. RESULTS:The articular process of type W was aligned with a sagittal facet, which was rarely seen in NS(6.89%), but was quitely frequent in DS(45.71%), and the articular process of type X1 was aligned with a coronal facet and was quitely frequent in LDH(58.33%) and NS(55.17%). Most spinal canals of type W were trefoil with narrow lateral recesses, which might be caused by slip and associated with osteoarthritis of the facet joints. CONCLUSION:Type W lamina is a potential factor for the occurrence of DS and spinal stenosis.