年龄对腰椎关节突关节水平化和矢状化的影响

Impacts of Age on Lumbar Facet Joint Horizontalization and Sagittalization

目的探究腰椎关节突关节的角度和退变程度随年龄增长的变化趋势,以说明年龄因素是否对腰椎关节突关节水平化和矢状化的形成有影响。方法本研究为回顾性研究,随机选取2015年1月—2018年1月于郑州大学第一附属医院门诊及体检中心行腰椎64排CT检查的非腰椎疾病患者共计180例(男性96例,女性84例)。将所有研究对象按照年龄划分为6个组,第1组:20~30岁(除外儿童、青少年),第2组:31~40岁,第3组:41~50岁,第4组:51~60岁,第5组:61~70岁,第6组:>70岁,每组均包括30例研究对象。在CT图像上分别测量各组人群L4/5节段的关节突关节角和关节突关节椎弓根角(pediclefacetangle,P-F角),和评估各组L4/5节段关节突关节退变严重程度,比较不同年龄组之间角度和退变程度是否有差异,并分析角度和退变与年龄之间的相关性。结果第1组至第6组,L4/5关节突关节角的大小分别为(52.37°±2.49°)、(48.12°±2.27°)、(45.63°±1.28°)、(43.73°±2.14°)、(41.51°±1.38°)、(37.95°±3.26°)(P<0.001);L4/5P-F角分别为(100.34°±1.42°)、(103.62°±1.26°)、(105.36°±2.06°)、(108.12°±1.05°)、(109.25°±1.31°)、(109.83°±2.29°)(P<0.001);不同年龄组之间L4/5关节突关节退变程度的差异具有统计学意义(M-Hχ2=86.335,P<0.001)。年龄与L4/5关节突关节角之间具有负相关关系(r=-0.747,P<0.05);年龄与L4/5P-F角之间具有正相关关系(r=0.695,P<0.05);年龄与L4/5关节突关节退变程度之间同样呈正相关关系(Gamma=0.916,P<0.05)。结论与年龄相关的退变过程可能导致腰椎关节突关节发生结构重塑,产生水平化和矢状化的形态学改变。因此,年龄增长很可能是引起腰椎关节突关节产生水平化和矢状化的重要因素。

Objective To explore variation trend of lumbar facet joint’s angle with age as well as degeneration severities with age,and explain whether age affects lumbar facet joint horizontalization and sagittalization. Methods A total of180 cases( incl. 96 males and 84 females) without lumbar vertebral disease,who underwent lumbar 64-row CT scan in the outpatient department and the physical examination center of our hospital during January,2015 to January,2018,were randomly selected in this retrospective study. Based on age,all the study subjects were divided into 6 groups( n =30 for each group) : group 1: 20-30 years of age( excluding children and adolescents),group 2: 31-40 years,group3: 41-50 years,group 4: 51-60 years,group 5: 61-70 years,and group 6: > 70 years of age. On CT images,L4/5 facet joint angles and pedicle fact angles( P-F angles) of different groups were measured; the severity of L4/5 facet joint degeneration of different groups were evaluated,to determine whether the angles and degeneration severities were different in different age groups,and to analyze correlation between the angles and age as well as degeneration severities and age. Results From the first group to the sixth group,L4/5 facet joint angles are 52. 37° ± 2. 49°,48. 12° ± 2. 27°,45. 63° ± 1. 28°,43. 73° ± 2. 14°,41. 51° ± 1. 38° and37. 95° ± 3. 26° respectively( P < 0. 001),while the L4/5 P-F angles are 100. 34° ± 1. 42°,103. 62° ± 1. 26°,105. 36° ± 2. 06°,108. 12° ± 1. 05°,109. 25° ± 1. 31° and 109. 83° ± 2. 29°respectively( P < 0. 001). There was significant difference in severity of L4/5 facet joint degeneration between different age groups( M-H χ2= 86. 335,P <0. 001). Age is negatively correlated with L4/5 facet joint angle( r =-0. 747,P < 0. 05),but positively correlated with L4/5 P-F angle( r = 0. 695,P < 0. 05) and the severity of L4/5 facet joint degeneration( Gamma = 0. 916,P < 0. 05).Conclusion The course of age related degeneration might result in structural remodeling of lumbar facet joint and lead to morphological changes of horizontalization and sagittalization. Therefore,increase of age is likely to be an important factor leading to horizontalization and sagittalization of lumbar facet joint.