青年男性官兵下腰椎小关节方向与椎间盘退变及椎间盘突出的关系研究

Relationships between lower lumbar facet joint orientation and lumbar intervertebral disc degeneration&disc herniation in young servicemen

目的分析青年男性官兵的下腰椎小关节方向与椎间盘退变、椎间盘突出的可能关系。方法收集下腰痛青年男性官兵的腰椎CT及MRI影像学资料,在腰椎间隙CT断层成像上测量L3~S1腰椎小关节的矢状位角度,根据椎间盘退变Pfirrmann分级量表在腰椎MRI成像上评价L3~S1各椎间盘的退变分级,比较不同退变分级各组的小关节角度,分析小关节方向和腰椎间盘退变的关系;比较小关节角度对称组与不对称组的椎间盘退变分级,分析小关节不对称与椎间盘退变的可能关系。比较腰椎间盘突出组和非突出的小关节角度、小关节不对称发生率,分析小关节方向和不对称与椎间盘突出的可能关系。结果纳入78例患者共测量234对小关节方向,L3~S1小关节矢状角逐渐增大(P<0.0001)。L3-4、L4-5、L5S1椎间盘Ⅰ~Ⅳ级退变各组的小关节角度比较,差异无统计学意义(P=0.18,P=0.14,P=0.72)。L3~S1共有36对小关节不对称,小关节不对称组和对称组的椎间盘退变分级比较,差异无统计学意义,L3~S1分节段进行统计分析,不对称组和对称组间椎间盘退变分级差异无统计学意义(P=0.66,P=0.62,P=0.59)。椎间盘突出组和非突出组比较,L5S1节段小关节角度差异有统计学意义(P=0.048);小关节不对称的占比差异有统计学意义(P=0.0043),分节段进行统计分析,仅L5S1节段差异有统计学意义(P=0.012)。结论本组青年男性官兵的腰椎小关节矢状角度自L3~S1逐渐增大,逐渐趋向冠状化。小关节方向、小关节不对称和腰椎间盘退变分级之间无明显关系。L5S1椎间盘突出时,小关节方向更趋于冠状化,同时该节段小关节不对称的发生率更高。

Objective To analyze the relationships between lumbar facet orientation and lumbar intervertebral disc degeneration & disc herniation in young male soldiers and officers.Methods The lumbar CT and MRI radiographic data on young servicemen was collected,the lumbar sagittal facet joint angle(FJA) of L3-S1 was measured in the axial CT sections and the disc degeneration grade was evaluated in MRI films according to the Pfirrmann grading of intervertebral disc degeneration.The relationship between facet orientation and disc degeneration was analyzed,and FJA was compared between different disc degeneration grade groups.The correlation between facet tropism(FT) and disc degeneration was analyzed by comparing disc degeneration grades between the facet tropism(FT) group and facet symmetry(FS)group.The FJA and incidence of FT were compared between the lumbar intervertebral disc herniation(LDH) group and non-herniation(NLDH) group to analyze the association of facet orientation with LDH.Results Seventy-eight cases were enrolled and 234 pairs of lumbar facet joints were measured.FJA gradually increased from L3 to S1(P<0.0001).There was no statistically significant different in FJA between Ⅰ-Ⅳ disc degeneration groups(L3-S1,P=0.18,P=0.14 and P=0.72).There were 36 pairs of FT in L3-S1, and no significant difference was found in any single level from L3 to S1(P=0.66,P=0.62,P=0.59).FJA in L5 S1 segment was significantly different between LDH and NLDH groups(P=0.048).There was significant difference in the percentage of FT between LDH and NLDH groups(P=0.0043).Only L3 S1 segment was statistically significant(P=0.012).Conclusion FJA gradually increases and becomes more coronal from L3 to S1.Neither facet orientation nor FT has any.obvious correlation with disc degeneration.Whenever LDH occurs in L3 S1,FJA becomes more coronal and FT becomes more likely.