腰椎管狭窄症患者腰椎关节突关节退行性变化的MRI影像评估

Degenerative changes of lumbar facet joint in patients with lumbar spinal stenosis by MRI

背景:腰椎管狭窄症是临床中常见病,其影像学表现及病因复杂,目前在腰椎关节突关节退变影像学方面研究较少,有待进一步探讨。目的:运用MRI观察腰椎管狭窄症患者腰椎小关节突骨性关节炎与腰椎小关节角的影像学变化,并分析两者之间的关系。方法:通过MRIT2WI横断面的观察,对120例腰椎管狭窄症患者L4/5、L5/S1节段双侧腰椎小关节角进行测量并评定两侧腰椎小关节突骨性关节炎等级,观察不同节段双侧腰椎小关节角与腰椎小关节突骨性关节炎MRI影像学变化,分析两者之间的关系。所有患者对检查方案知情同意,且得到医院伦理委员会批准。结果与结论:①L4/5、L5/S1同节段左右两侧腰椎小关节角差异有显著性意义(P<0.05);②在同节段不同等级腰椎小关节突骨性关节炎组间,双侧病例数比较差异无显著性意义(P> 0.05),而两侧腰椎小关节角差异有显著性意义(P <0.05);③两节段中腰椎小关节角与年龄、性别、体质量指数无相关性(P> 0.05),而性别、体质量指数与左侧腰椎小关节突骨性关节炎等级之间存在弱相关性(P <0.05),且腰椎小关节角与腰椎小关节突骨性关节炎等级之间成负等级相关(P <0.05);④结果提示,腰椎管狭窄症患者腰椎小关节角与腰椎小关节突骨性关节炎之间存在负相关关系。腰椎小关节突骨性关节炎越严重,腰椎小关节越偏向矢状位,两者病理改变是椎管狭窄的重要影像学特征,可为临床医师正确、深入认识椎旁结构退变对疾病的影响提供依据。

BACKGROUND: Lumbar spinal stenosis is a common disease in the clinic, and the imaging manifestations and etiology are complex. There are few studies on the degeneration of lumbar facet joints, which needs further investigation. OBJECTIVE: To investigate the relationship between lumbar facet joint arthritis and lumbar facet joint angle in cross-sectional observation of MRI in patients with lumbar spinal stenosis. METHODS: In T2WI of MRI, L4/5 and L5/S1 segment bilateral lumbar facet joint angle of 120 patients with lumbar spinal stenosis was assessed and we measured the lumbar facet joint angle grade on both sides. Then, the changes of bilateral lumbar facet joint angle of different segments and lumbar facet joint angle MRI were observed. Finally, the relationship among them was analyzed. Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital. RESULTS AND CONCLUSION:(1) There were significant differences between L4/5 and L5/S1 in the angle of lumbar facet on the left and right sides of the same segment (P < 0.05).(2) There was no significant difference in the number of bilateral cases between lumbar facet joint angle groups with different grades of the same segment (P > 0.05), while there were significant differences in the angle of bilateral lumbar facet joints (P < 0.05).(3) For lumbar facet angle, it showed no correlation with age, gender and body mass index in the two segments (P > 0.05), while lumbar facet joint angle grade on the left showed little correlation with gender and body mass index (P < 0.05), and there was a negative correlation between lumbar facet angle and lumbar facet joint angle grade (P < 0.05).(4) In summary, there is a negative correlation between lumbar facet angle and lumbar facet joint angle in patients with lumbar spinal stenosis. The more severe lumbar facet joint angle is, the more sagittal the lumbar facet joint is. The pathological changes of them are important imaging features of spinal stenosis, providing evidence for clinicians to understand the influence of paravertebral structural degeneration correctly and deeply.