下位腰椎小关节面形态及方向与椎间盘退变的关系

CORRELATION BETWEEN SHAPE AND DIRECTION OF SMALL ARTICULAR SURFACE IN LOWER LUMBAR VERTEBRAE AND DEGENERATION OF INTERVERTEBRAL DISC

用ＣＴ图像观测１５２例经ＣＴ，ＭＲＩ或手术证实的Ｌ４－５及Ｌ５－Ｓ１椎间盘退变或正常的患者之相应小关节面形态及小关节面水平夹角（ＴＩＦＡ）。结果显示：Ｌ４－５椎间盘退变率及其小关节面呈弧形改变率均高于Ｌ５－Ｓ１单元；Ｌ５－Ｓ１椎间盘退变率与Ｌ４－５ＴＩＦＡ呈正相关，与Ｌ５－Ｓ１ＴＩＦＡ呈负相关，与Ｌ５－Ｓ１和Ｌ４－５ＴＩＦＡ差值呈特殊相关。提示下位腰椎间盘退变与小关节面形态及方向变化有关。

To assess the possible correlation between the shape and the direction of the small articular surface in the lower lumbar vertebrae and the degeneration of the intervertebral disc, we investigated with computed tomography (CT) and evaluated with statistics the small articular surface and the transverse interface joint angle (TIFA) of the L 4-5 and the L 5 S 1 in 152 cases who had normal or degenerative discs verified through CT, MRI or operation. The small articular surface was found arc in 69.1% of the L 4-5 and in 23.0% of the L 5 S 1. The TIFA of the L 4-5 was less than that of the L 5 S 1. There was no correlation between the ratio of degeneration of the intervertebral disc at the L 4-5 and the TIFA of the L 4-5 and the L 5 S 1, but the ratio of degeneration of the intervertebral disc at the L 5 S 1 had postive correlation with the TIFA of the L 4-5 , negative correlation with the TIFA of the L 5 S 1, and particular correlation with the TIFA of the L 5 S 1 and L 4-5 . These results suggest that the shape and direction of the lower lumbar facet joint are related to the lumbar degeneration of intervertebral disc and the causes of degeneration at the L 4-5 disc differ from those at the L 5 S 1 disc in biomechanics.