腰椎小关节角度变异在腰椎滑脱症中的作用

The influence on isthmlc spondyloUsthesis from lumbar vertebras facet joint orientation variation

目的探讨腰椎小关节角度变异对腰椎滑脱症的影响。方法收集60例因腰痛就诊行腰椎CT扫描的病例，将椎弓崩解性腰椎滑脱30例设为病例组；腰椎未见明显异常30例设为对照组。分别比较病例组与对照组在每个层面的小关节角度差异、腰椎小关节的两侧角度差异，并与国外60例在同一层面的数据进行比较。结果病例组在L3-4、L4-5、L5-S1层面右侧腰椎小关节角度分别为（47.9±6.3）°、（37.5±7.3）°、（37.9±7.7）°，对照组分别为（53.1±7.3）°、（40.5±6.3）°、（38.5±7.3）°，病例组在L3-4、L4-5、L5-S1层面右侧腰椎小关节角度分别为（48.1±6.0）°、（37.9±7.4）°、（37.6±7.6）°，对照组分别为（52.3±7.6）°、（41.6±6.0）°、（38.2±7.2）°，两组在L3-4、L4-5层面比较差异有统计学意义（P〈0.05），而两组在L5-S1层面比较差异无统计学意义（P〉0.05）。腰椎小关节两侧角度在L3-4、L4-5、L5-S1层面比较差异均无统计学意义（P〉0.05）。国内、国外病例腰椎小关节角度L3-4、L4-5、L5-S1层面比较差异均无统计学意义（P〉0.05）。结论腰椎小关节角度减小可能是椎弓崩解性腰椎滑脱的一种基因表达。通过测量腰椎小关节角度，可以早期发现病变，对减少、减轻腰椎滑脱有重要意义。

Objective To explore the influence on isthmic spondylolisthesis （IS） from lumbar vertebras facet joint orientation （FJO） variation. Methods The lumbar vertebras of 60 patients scanned by 16-slices spiral CT were collected, 30 cases with IS was defined as isthmie group;30 cases with normal lumbar vertebras was defined as control group, the FJO at L3-4, L4-5 and L5-S1 were measured in two groups. The difference between two groups were compared at three levels, the difference between both sides of the facet joint orientation also was compared; the measured data and the data of 60 patients from foreign literature were compared at three levels. Results The FJO in isthmic group were （47.9±6.3）°,（37.5±7.3）°, （37.9±7.7）° at the right of L3-4, L4-5, L5-S1 levels respectively,the FJO in control group were （53.1±7.3）° , （40.5±6.3）°, （38.5±7.3）° respectively, the FJO in isthmic group were （48.1±6.0）°, （37.9±7.4）°, （37.6±7.6）° at the left of L3-4, L4-5, L5-S1 levels respectively, the FJO in control group were （52.3±7.6）°, （41.6±6.0）°, （38.2±7.2）° respectively. The significant difference was found at L3-4 and L4-5 levels （P〈0.05）, the orientation was similar at L5-S1 level （P 〉 0.05）. The difference between the both sides FJO of lumbar vertebras was not found at L3-4, L4-5 and L5-S1 levels （P 〉 0.05）. The same as the measured data and the corresponding data from foreign literature（P 〉 0.05）. Conclusions It seems possible that the coronal FJO may be the phenotypic representation of the familial etiology of IS. It is helpful for the measurement of lumbar vertebras FJO to find IS early,it is important to reduce and release the IS.