腰椎小关节突不对称与椎间盘突出症

Relation of lumbar articular facet asymmetry to intervertebral disc herniation

目的 探讨腰椎间盘突出症患者小关节突不对称的意义。方法 对63 例具有腰椎间盘突出症临床及影像学表现的患者进行回顾分析,MRI 测量判断突出间隙有无小关节不对称,据此进一步分析其与椎间盘突出间隙、突出方向和程度以及椎间盘退变程度是否存在相关关系。结果 60-3 % 患者小关节突不对称, 各腰椎间隙发生情况相近。小关节突不对称组78-9 % 椎间盘突出为后外侧型,且突出方向大多数偏向小关节角大的一侧;小关节突对称组68-0 % 为椎间盘中央型突出。两组统计学差异有高度显著性( P< 0-01 ) 。小关节突不对称与椎间盘突出和退变程度无明显联系。结论 L3 ～4 ,L4 ～5 及L5 ～S1 小关节突不对称发生椎间盘突出的危险性相似;后外侧型椎间盘突出小关节突不对称发生机率较中央型高;椎间盘突出和退变的程度与小关节突是否对称无明显关系。

Objective To investigate the effect of lumbar articular facet asymmetry in patients with intervertebral disc herniation. Methods 63 symptomatic patients of the disease were reviewed. The facet joint angle of each herniated interspace was measured by magnetic resonance imaging to determine the facet asymmetry. The incidence of facet asymmetry and the relationship between the facet asymmetry and the location, type of disc herniation and disc degeneration were examined. Results 60 3% patients were found to have facet asymmetry. There was no statistical difference in distribution of facet asymmetry among measured vertebral levels, and 78 9% had posterolateral herniation, which were predominantly found on the side of larger facet joint angle. 68 0% patients with facet symmetry had central herniation. The difference between facet asymmetry and the location of disc herniation was highly significant ( P <0 01). There was no significant correlation between facet asymmetry, type of disc herniation and disc degeneration. Conclusion Facet asymmetry among L 3～4 , L 4～5 , and L 5～S 1 has similar risk in the development of disc herniation. Facet orientation in posterolateral herniation is more asymmetrical than that in central herniation. The type of disc herniation and disc degeneration appears not to be related to facet asymmmetry.