腰椎节段不稳的影响因素

A clinical study on segmental instability of the lumbar spine

目的 探讨腰椎节段不稳定的影响因素。方法 选择 5 7例L4～ 5节段不稳患者作为疾病组 ,2 2例L4～ 5节段手术患者作为术后对照组 ,19例健康检查者作为正常对照组。所有患者均拍摄正、侧位和过屈、过伸位X线片 ,CT扫描测量关节突形态 ,3 6例腰椎节段不稳患者行MRI检查 ,评价椎间盘退变情况。结果 前屈移位不稳患者关节突关节角方向偏向矢状 ,旋转不稳患者的椎间盘退变程度较轻 ,关节突全切患者存在前移不稳。结论 关节突矢状方向排列和椎间盘退变与前移不稳有关 ,可能是腰椎滑脱的原因 ,而韧带损害与旋转不稳有关。

Objective To explore factors related to the development of segmental instabilities in lumbar spine. Methods Fifty-seven patients with lumbar segment instabilities at L 4～5 were selected as illness group, 22 patients with facetectomy at L 4～5 as post-operation control group, and 19 healthy subjects as normal control. X-ray plain films were taken in sagittal,flexion and extension positions. Computed tomographic scans were taken to define the axial morphology of the facet joint. Magnetic resonance scans were taken to describe disc degeneration of 36 patients in illness group. Results The facet joint was oriented sagittally in the forward translation patients in flexion. The disc degeneration was slight in the rotational instability patients. The patients with total facetectomy exited forward translation in flexion. Conclusion A more sagittally oriented facet and disc degeneration are associated with forward translation in flexion and may be the cause of degenerative spondylolisthesis, whereas ligament failure is associated with rotational instability.