关节突关节角变化与退变性腰椎滑脱间关系的研究

tiological relationship between the facet joint angle and degenerative lumbar spondylolisthesis

目的探讨关节突关节角的改变与退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)发生之间的因果关系。方法回顾性选取2011-07-2014-07我科收治的50例L4-5单节段退变性前滑脱患者作为DLS组,另选同期50例无腰腿痛和脊椎滑脱的正常患者作为对照组,且使性别、年龄与DLS组相匹配。两组均行站立位腰椎正侧位X线片及腰椎三维CT检查,在腰椎侧位X线上测量腰椎滑脱指数;在CT矢状位图像上选取平行于L3-4、L4-5、L5-S1椎间隙上缘终板的CT横断位图像作为关节突的头侧部分;过椎弓根下缘且平行于L3-4、L4-5、L5-S1椎间隙下缘终板的CT横断图像作为关节突的尾侧部分,在横断位上进行关节突角度测量,同时在骨窗下对关节突的退变进行评估。结果 DLS组L3-4头侧关节突关节角(61.9±6.3)°大于对照组的(56.3±7.5)°,尾侧关节突关节角(57.1±6.9)°大于对照组的(51.9±6.8)°;DLS组L4-5头侧关节突关节角(55.8±5.6)°大于对照组的(50.2±6.7)°,尾侧关节突关节角(53.2±6.8)°大于对照组的(47.0±5.9)°;DLS组L5-S1头侧关节突关节角(49.1±7.8)°大于对照组的(43.9±6.9)°,尾侧关节突关节角(45.1±6.9)°大于对照组的(41.7±5.1)°,差异均具有显著性(P<0.05)。DLS组患者L4-5头尾侧角度差值(2.1±0.8)°小于对照组的(5.0±1.3)°,差异具有显著性(P<0.05)。DLS组L4-5左右两侧关节突关节角不对称度(8.0±2.0)°大于对照组的(4.2±1.3)°,差异有显著性(P<0.05)。按关节突关节退变等级将DLS患者分成3组,各组间滑脱指数差异具有显著性(P<0.05),不同退变等级中头、尾侧关节突关节角度差异具有显著性(r=0.457,P<0.05)。结论关节突关节矢状化改变更可能是腰椎退变性滑脱发生预先存在的解剖学因素。

Objective To investigate the etiological relationship between the angle of facet joint and degenerative lumbar spondylolisthesis（DLS）. Methods From July 2011 to July 2014, 50 patients with DLS at L4-5 were enrolled as the research group. 50 patients without back pain or spondylolisthesis were selected as the control group. The patients in two groups were matched in gender and age. Both two groups received CT scan and X-ray examination. The degree of spondylolisthesis（Boxall index） was measured by X-ray image. The cranial CT image of facet joint was selected through the inferior endplate of upper vertebrae, and caudal image was selected on the level of superior endplate of the lower vertebrae. The angle formed with facet joints and coronal of the vertebral bodies was measured. The degree of degeneration of facet joints was classified under CT window of bone. Results In DIS group, L3-4 cephalic facet joints（61.9±6.3） and caudal facet joints （57.1±6.9）° were higher than those in the control group [（56.3±7.5）°, （51.9±6.8）°]. The L4-5 cephalic facet joints（55.8±5.6） and caudal facet joints （53.2 ± 6.8°）of DLS group were higher than those in the control group [（50.2±6.7）°, （47.0±5.9）1]. The L5-S1 cephalic facet joints（49.1±7.8） and caudal facet joints （45.1±6.9）° in DIS group were higher than those in the control group [（43.9±6.9 ）1, （41.7±5.1）°], and the differences were statistically significant （P〈0.05）. The L4-5 head to tail side angle difference of DIS patients was （2.1±0.8）°, which was less than（5.0±l.3）° of the control group（P〈0.05）. The L4-5 right and left facet joints asymmetry of DIS group was （8.0±2.0）°, which was higher than （4.2±1.3）° of the control group （P〈0.05）. Stratified by the facet joint degeneration rating, DIS patients were divided into three groups, the difference of slipping Boxall index between the groups was significant （P〈0.05）, and the differences of degenerative hierarchy head, caudal facet joint angle were statistically significant（r=0.457,P〈0.05）. Conclusion Articular process change sagittal angle is a pre-existing anatomical factors of the lumbar degenerative slippage.