腰椎小关节方向性与腰椎间盘突出症

Lumbar facet orientation in patients with lumbar disc herniation

背景:腰椎小关节及其对称性与腰椎间盘突出之间是否存在关系,文献报道争议很大。目的:测量分析腰椎小关节方向性与腰椎间盘突出的关系。方法:收集因腰腿痛行CT检查的169例患者,L4/5腰椎间盘突出35例,L5/S1腰椎间盘突出67例,无间盘突出对照组67例。在CT终端机上选取L3～S1椎间隙的远侧椎体上终板层面,测量3个节段的腰椎小关节角。结果与结论:①L4/5和L5/S1腰椎间盘突出组L3/4、L4/5、L5/S1每个节段腰椎小关节角左侧均大于右侧(P<0.05);各组小关节前内侧角和后外侧角两侧相比差异均无显著性意义(P>0.05)。②各节段腰椎小关节角、前内侧角、后外侧角3组之间比较没有显著性差异(P>0.05)。③各组腰椎小关节角、后外侧角自L3/4至L5/S1节段均逐渐增大(P<0.05);而前内侧角L4/5节段最大,L3/4节段最小(P<0.05)。提示腰椎间盘突出与腰椎小关节角左右侧不相等有关;腰椎小关节角和后外侧角自L3/4至L5/S1逐渐更偏向冠状位,而内侧角在L4/5节段更偏冠状位,可能与腰椎管狭窄的发病有关。

BACKGROUND：The relationship between lumbar facet orientation and lumbar disc herniation（LDH） is the one of the research focus in the spine.But that does not reach consensus.OBJECTIVE：To investigate the relationship of lumbar facet orientation to LDH.METHODS：A total of 169 backleg pain patients were examined with CT,which were in three groups.L4/5 LDH was 35 subjects in group A,L5/S1 LDH was 67 subjects in group B and the other 67 subjects（control group） were normal in CT examination in group C.All measurements were performed using bone window CT images.The plane was selected aligned parallel to the vertebral up endplate.The lumbar facet was separated in anteriomedialis-angle and posteriolateralis-angle based on the most depressed of the lumbar facet.The three angles between left and right in one group and in the three groups were compared respectively.RESULTS AND CONCLUSION：①For groups A and B,the left angle was bigger than the right in the lumbar facet angle（P 0.05）;while the control group had no difference between both sides（P 0.05）;and there was no difference between the both sides for three groups in anteriomedialis-angle and posteriolateralis-angle（P 0.05）.②Difference in lumbar facet angle,anteriomedialis-angle and posteriolateralis-angle was not found in the three groups（P 0.05）.③The lumbar facet angle and posteriolateralis-angle were gradually increased from L3/4,L4/5 and L5/S1 in all subjects（P 0.05）;while the L4/5 was the biggest,the L3/4 was the smallest for the anteriomedialis-angle（P 0.05）.There are some associations between lumbar intervertebral disc herniation and lumbar facet angle asymmetry.The lumbar facet angle and posteriolateralis-angle is more and more coronal from L3/4,L4/5 and L5/S1 in all subjects and the anteriomedialis-angle is more coronal in L4/5,which may cause lumbar spinal stenosis.