腰椎小关节骨性关节炎的病理学及影像学对比研究

Comparison between pathologic changes and imaging changes in lumbar facet joint osteoarthritis

目的对比腰椎小关节骨性关节炎的病理学及影像学检查之间的关系。方法选取我科接受后路腰椎手术的患者共20例,其中男性8例,女性12例。采用Weishaup分级标准评估小关节退变程度;甲苯胺蓝染色法后镜下观察关节软骨组织学改变,采用Nicola提出的分级法对软骨的退变程度进行分级。结果对比影像学分级与软骨退变病理学分级,其中影像学0级时软骨退变1级1例,2级1例,3级1例;影像学1级时组织学软骨退变1级1例,3级1例,4级1例;影像学退变2、3级时组织学软骨退变均为3、4级。镜下观察到的病理改变与退变的软骨病变、坏死现象完全一致;在影像学检测小关节退变0级与1级时,个别软骨病理学分级较为严重,与影像学分级明显不符。而影像学退变2、3级时组织学软骨退变均为3、4级,影像学检查与病理学分级相符程度很高。结论临床诊断上,CT与MRI在诊断早期小关节骨性关节炎还有一定的局限性,但其在诊断中晚期小关节骨性关节炎时参考意义较大。

Objective To investigate the relationship between pathologic changes and imaging changes in lumbar facet joint osteoarthritis.Methods The pathologic changes and imaging changes of 20 patients（male 8,female 12） admitted to our department for posterior lumbar spinal surgery were comparied.The grades of degenerative arthrosis of the patients were evaluated according to the Weishaup grading criteria.The histological changes of their articular cartilages were observed by means of toluidine blue staining and graded using the classification method proposed by Nicloa.Results Three cases were graded 1,2 and 3 respectively in histological study while they were all graded 0 in imaging examination.Another three cases were graded 1,3 and 4 respectively in histological study while they were graded 1 in imaging examination.The other cases were graded 3 or 4 while they were grade 2 or 3 in imaging examination.Meanwhile,the pathological results were consistent with the results of histological study,but suggested severer changes compared with the results of imaging examination.Conclusion CT and MRI have some limitations in the early diagnosis of facet joint osteoarthritis,though they may provide a good reference in the diagnosis of late facet osteoarthritis.