腰椎关节突关节骨性关节炎的CT分级及其临床意义

Investigation of the computed tomography grading of lumbar facet joint osteoarthritis and its clinical significance

目的:探讨腰椎关节突关节骨性关节炎的CT分级及其临床意义。方法:回顾性分析2008年1月～2010年12月在我院就诊的100例腰痛或腰痛伴下肢麻木疼痛患者的腰椎CT。男43例,女57例;年龄23～81岁,平均52.5岁。采用CT骨窗轴位像关节突关节的关节间隙宽度、骨赘形成及骨质变化情况作为分级依据征象,将每个征象按照其严重程度分为4个等级,相应赋予0～3分,按3个征象总分分为4级:0级,0分;Ⅰ级,1～3分;Ⅱ级,4～6分;Ⅲ级,7～9分。由初、中、高级职称3位医师在PACS系统对100例患者从L1/2至L5/S1节段的双侧关节突关节分别进行2次独立分级,Kappa分析评价3位医师分级结果的一致性。同时对患者腰痛VAS评分、Oswestry功能障碍指数(ODI)和年龄与分级结果进行Spearman相关分析。结果:3位医师分别2次对100例患者的1000个腰椎关节突关节进行分级,0级200～211个(20.0%～21.1%),Ⅰ级384～403个(38.4%～40.3%),Ⅱ级301～310个(30.1%～31.0%),Ⅲ级85～106个(8.5%～10.6%)。同一医师前后分级一致的关节突关节数为84.1%～88.4%,Kappa值为0.773～0.833;不同级别医师分级一致的关节突关节数为82.9%～87.9%,Kappa值为0.756～0.827。患者VAS评分和ODI与分级结果的相关系数分别为0.186、0.192,无显著相关性(P>0.05);年龄与分级结果的相关系数为0.558,呈显著性正相关(P<0.05)。结论:腰椎关节突关节骨性关节炎CT分级具有良好的一致性,对关节突关节退变程度的评估和研究有指导意义;腰椎关节突关节骨性关节炎CT分级与年龄呈正性相关,而与腰痛程度及腰椎ODI无显著相关性。

Objective：To investigate the computed tomography grading system of lumbar facet joint osteoarthritis and its clinical significance.Method：From January 2008 to December 2010,a retrospective study was carried out in 100 consecutive patients with low back pain and/or leg symptoms,who were referred to our hospital and underwent CT examination of the lumbar spine.There were 43 male patients and 57 female patients with average age of 52.5 years（range,23-81 years）.The facet joint spaces width,osteophyte formation and subchondral sclerosis or cysts in the CT axial bone views were regarded as grading signs.Every sign was divided into four types on the basis of severity degrees,and corresponding scores were 0 to 3.The grades of osteoarthritis on CT were scored on the same four-point scale according to total scores：grade 0,normal;grade Ⅰ,1-3 scores;grade Ⅱ,4-6 scores;grade Ⅲ,7-9 scores.Three independent spine surgeons（ranking as senior,middle,and primary） respectively evaluated CT images of facet joints from the L1/2 through L5/S1 levels of 100 consecutive patients two times on the PACS system.Kappa analysis was used to evaluate the consistency of the results of grading.To investigate the Spearman correlation of the visual analog scale（VAS） scores and Oswestry disability indexs（ODI） and age with the CT grading of lumbar facet joint osteoarthritis.Result：A total of 1000 facet joints from 100 consecutive patients were evaluated by three independent spine surgeons two times respectively.200-211 joints（20.0%-21.1%） were considered to be grade 0,384-403（38.4%-40.3%） grade 1,301-310（30.1%-31.0%） grade 2,85-106（8.5%-10.6%） grade 3.The Kappa values of intraobserver were ranged from 0.773 to 0.833,representing substantial or excellent agreement in 84.1%-88.4% of 1000 joints.The Kappa values of interobserver were ranged from 0.756 to 0.827,representing substantial or excellent agreement in 82.9%-87.9% of 1000 joints.The VAS scores and ODI had no significant correlations with the average CT grading of lumbar facet joint osteoarthritis（r=0.186,0.192,P〉0.05）.The average CT grading of lumbar facet joint osteoarthritis existed a positive correlation with age（r=0.558,P〈0.05）.Conclusion：The CT grading system to assess the severity of lumbar facet joint osteoarthritis is presented good reliability,which can be helpful in research.Lumbar facet joint osteoarthritis exists a positive correlation with age,but has no significant correlations with low back pain VAS and ODI.