腰椎关节突关节的方向和退变程度对退行性腰椎滑脱的影响

The affections of the orientations and the severity of degeneration of facet joints to the degenerative lumbar spondylolisthesis

目的：探讨退行性腰椎滑脱（degenerative lumbar spondylolisthesis,DLS）患者腰椎关节突关节的方向与退变程度的变化规律及其临床意义。方法：随机选取2002年7月～2007年7月我科收治的DLS患者52例作为观察组,同期年龄、性别相匹配的非DLS志愿者50例作为对照组。将所有研究对象的CT片、侧位X线片图像输入计算机,测量L4/5关节突关节的关节面与椎体矢状面的夹角、L4椎体前后缘中点连线与椎间关节突关节间隙的夹角（关节突关节-椎弓根角）,在CT片上观察关节突关节退变的程度,并对所测参数进行相关性分析。结果：DLS患者的关节突关节与椎体矢状面的夹角与对照组比较更偏向呈矢状位（34.93°±9.14°vs47.22°±5.37°,P〈0.001）,关节突关节-椎弓根角更倾向于水平位（113.57°±5.96°vs102.50°±4.96°,P〈0.001）,关节突关节的退变程度与其方向的改变高度相关。结论：DLS与关节突关节方向矢状化及水平化相关,腰椎关节突关节的关节面方向矢状化与关节突关节退变程度高度相关,腰椎关节突关节退变程度及其方向的变化对DLS具有病因学意义。

Objective：To investigate the relationship between the orientations and the severity of degeneration of facet joints and the degenerative lumbar spondylolisthesis ,and to explore it＇s clinical significance.Method： From July 2002 to July 2007,52 cases of degenerative lumbar spondylolisthesis （DLS）,who were undergone operation were reviewed.50 volunteers without spondylolisthesis were studied as control group.The age and gender had not differences between each group.Lateral view of X ray and CT scans were inputted into computer.The angles of the L4/5 facet joints in axial plane were measured,and the pediele-facet angle was measured on the lateral view of X ray（a straight line from the midpoint of anterior edge of IA to the midpoint of posterior edge was drew,the other line was a prolonged line along with the facet joint space,the cross angle was measured ） .The severity of degeneration of facet joints was evaluated.The relativity analysis of obtained parameters was performed.Result：In DLS group,the orientation of the facet joints was more inclined to the sagittal plane than that of control group （34.93°＋9.14° versus 47.22°＋5.37°,P〈0.001）,and the pedicle-facet angle was more horizontal in the patients with DLS（113.57°＋5.96° versus 102.50°＋4.96°P〈0.001）.The severity of facet joints degeneration was significantly higher in the patients with DLS than the control group （P〈 0.001 ）,and there was significant correlation between the severity of facet joints degeneration and the orientation of the facet joints angles.Conclusion：There was significant correlation between the severity of facet joints degeneration and the orientation of the facet joints angles.There was significant correlation between degenerative spondylolisthesis and the orientation of facet joints angle and pedicle-faeet angle.The orientation and degeneration degree of the facet joints has an important etiologic meaning in the occurrence of DLS.