Does therapist's attitude affect clinical outcome of lumbar facet joint injections?

AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.

Association between facet joint osteoarthritis and the Oswestry Disability Index

AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman’s coefficient of rank correlation was used for statistical analysis,with significance set at P 【 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients’ disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.

Endoscopic joint capsule and articular process excision to treat lumbar facet joint syndrome:A case report

BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural interventions.For some refractory cases that fail conservative therapies,dorsal ramus medial brunch radiofrequency ablation is warranted.However,as nerve fibers can regenerate,their efficacy is impermanent,and the recurrence rate is relatively high.Considering synovial impingement is a paramount pathogenesis of LFJS,in this case,we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope.As the culprit hyperplastic joint capsule was excised,it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS.She complained of low back pain and right buttock pain for half a year.The patient was placed in the prone position.After disinfection and draping,a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process.Subsequently,a guidewire,dilating tubes,and a working cannula was inserted successively.The spinal endoscope was positioned in the working cannula.Under the endoscope,the microvascular tissue,muscle tissue attached on the L5 inferior articular process and S1 superior articular process,as well as the capsule and minor portion of the inferior articular process were removed.After the joint space was clear and no bleeding points existed,the endoscope and working cannula were shifted,and the incision was sutured.After treatment,the symptoms were completely relieved.The patient was pain-free during the follow-up period of 6 mo.CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS,especially for cases caused by synovial impingement.

Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.

Decompression via posterior-anterior approach and anterior fixation in treatment of fracturedislocation of the lower cervical spine with bilateral facet joints dislocation

Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This

Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint

AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS:Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography.Second injections were performed 5 d after the initial injection.All patients were followed up for 6-18 mo.A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS:Successful puncture was obtained in all patients.The overall efficacy was 91.4;the outcome was the excellent in 37 cases(63.8),good in 16 cases(27.6) and fair/poor in 5 cases(8.6) according to the Macnab criteria.No severe complications were found throughout this study.CONCLUSION:Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

Innervation of cervical ventral facet joint capsule: Histological evidence

AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed cadavers. Paraffin sections from these capsules were processed to identify neurofilament and substance P immunoreactive fibers. Nerve fiber presence was also verified by a silver impregnation method.RESULTS: Neurofilament reactive fibers were observed in sections from 9 capsules. They were observed in areas with collagen fibers and areas with irregular connective tissue. Substance P reactive nerve fibers were found in sections from 7 capsules in similar areas. Silver impregnation also revealed the presence of nerve fibers. The nerve fibers were also found as bundles in the lateral margins of the capsule. A Pacinian corpuscle-like ending was also observed in onespecimen.CONCLUSION: Nerve fibers revealed by neurofilament immunoreactivity and silver staining support innervation of the ventral aspect of the facet joint capsule. The presence of substance P reactive fibers supports the potential role of these elements in mediating pain. The presence of a Pacinian-like ending implicates a potential role in joint movement.

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Facet Joints Involvement in Rheumatoid Arthritis: A Cross-Sectional Study

Background: It has been accepted amongst rheumatologists that rheumatoid arthritis (RA) does not involve the facet joints (FJs) of the spine;nevertheless, the issue is still under debate. Objective: To compare the prevalence of FJs’ changes between patients with RA and age- and sex-matched peers. Methods: CT scans of 34 patients with RA suffering from low back pain (LBP) were compared with 70 age- and sex-matched controls (individuals without RA, suffering from LBP) in a case-control study. The degenerative changes in the FJs were evaluated (i.e., joint space narrowing, marginal osteophytes, articular process hypertrophy, subchondral sclerosis, inter-joint vacuum phenomenon, and subchondral cysts), in addition to the marginal erosions, the most characteristic feature of joint change in RA. Disease activity characteristics (CRP, ESR, DAS-28, SDAI, and CDAI), duration of RA, age, and sex were obtained from patients’ clinical charts. Results: The prevalence of FJs’ changes in patients with RA and age- and sex-matched controls were not significantly different at any spinal level or in a total L1-S1 score. Marginal erosions, a characteristic feature of joint changes in RA, were not found in any of our RA subjects. No difference was found in disease parameters and markers in individuals with RA with affected FJs and those without. The occurrence of FJs’ changes amongst subjects with RA demonstrated no correlation with disease duration and activity. Conclusions: FJs of the lumbar spine are not involved in the inflammatory process of RA, and their LBP is not due to inflammation in FJs of the spine.

CT-Guided Lumbar Facet Joint Infiltration: Accessibility, Accuracy and Functional Outcome

Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure;85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique;CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.

Lumbar spine superior-level facet joint violations： percutaneous versus open pedicle screw insertion using intraoperative 3-dimensional computer-assisted navigation

Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations （FVs） because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures clearly,and may help to lower the rate of FVs during pedicle screw insertion.This study used computed tomography （CT） to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.Methods A prospective study,including 142 patients having lumbar and lumbosacral fusion,was conducted between January 2013 and April 2014.All patients had bilateral posterior pedicle screw-rod instrumentation （top-loading screws） implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures.All patients underwent CT examinations within 6 months postoperation.The CT scans were independently reviewed by three reviewers blinded to the technique used.Results The cohort comprised 68 percutaneous and 74 open cases （136 and 148 superior-level pedicle screw placements,respectively）.Overall,superior-level FVs occurred in 20 patients （20/142,14.1％）,involving 27 top screws （27/284,9.5％）.The percutaneous technique （7.4％ of patients,3.7％ of top screws） had a significantly lower violation rate than the open procedure （20.3％ of patients,14.9％ of top screws）.The open group also had significantly more serious violations than did the percutaneous group.Both groups had a higher violation rate when the cranial fixation involved the L5.A 1-level open procedure had a higher violation rate than did the 2-and 3-level surgeries.Conclusions With computer-assisted navigation,the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur,they tend to be less serious.Performing a single-level open lumbar fusion,or the fusion of the L5-S1 segment,requires caution to avoid cranial adjacent FVs.

Load Rate of Facet Joints at the Adjacent Segment Increased After Fusion

Background： The cause of the adjacent segment degeneration （ASD） after fusion remains unknown. It is reported that adjacent facet joint stresses increase alter anterior cervical discectomy and fusion. This increase of stress rate may lead to tissue injury. Thus far, the load rate of the adjacent segment facet joint after fusion remains unclear. Methods： Six C2-C7 cadaveric spine specimens were loaded under tour motion modes： Flexion, extension, rotation, and lateral bending, with a pure moment using a 6° robot arm combined with an optical motion analysis system. The Tecscan pressure test system was used for testing facet joint pressure. Results： The contact mode of the facet joints and distributions of the force center during different motions were recorded. The adjacent segment facet joint forces increased faster after fusion, compared with intact conditions. While the magnitude of pressures increased, there was no difference in distribution modes before and after fusion. No pressures were detected during flexion. The average growth velocity during extension was the fastest and was significantly faster than lateral bending. Conclusions： One of the reasons for cartilage injury was the increasing stress rate of loading. This implies that ASD after fusion may be related to habitual movement before and after fusion. More and faster extension is disadvantageous for the facet joints and should be reduced as much as possible.

Sensory and sympathetic innervation of cervical facet joint in rats

Objective： To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions （DRGs） in order to clarify the causes of diffuse neck pain, headache, and shoulder pain. Methods： Forty-two male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into three groups： Group A （ n = 18） , Group B （ n = 18） , and Group C （ n = 6 ）. Under anesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 μl 5 % bisbenzimide （Bb） were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep reanesthesia with intraperitoneal pentobarbital sodium （45 mg/kg body weight）, C1 -C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined. Results ： Neurons labeled with Bb were present in C1- C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups, labeled neurons were present from C1to C8 DRGs, while in C5-6 subgroups they were from C3 to C8. The number of Bb （＋） neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb （ ＋ ） neurons after sympathectomy was significantly less than that without sympathectomy. Conclusions： The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with sympathetic ganglions through nerve fibers outside the central nerve system.

Management of lumbar zygapophysial (facet) joint pain

AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.

Sitting-pushing manipulation combined with bloodletting for 40 cases of thoracic facet joint disorder syndrome

Objective:To observe the clinical effect on thoracic facet joint disorder syndrome treated with the sitting-pushing manipulation,acupuncture at Yanglingquan(阳陵泉GB34)and bloodletting at Weizhong(委中BL40).Methods:A total of 40 patients of thoracic facet joint disorder syndrome were treated with the combined therapy of the sitting-pushing manipulation,acupuncture at GB34 and bloodletting at BL40,once every two days.The therapeutic effect was evaluated 6 days later.Results:After treatment,of 40 cases of thoracic facet joint disorder syndrome,31 cases were cured,5 cases improved,2 cases effective and 2 cases failed.The curative rate was 77.5%and the total effective rate was 95%.Visual analog scale(VAS)was(4.1±1.4)points before treatment and was(2.2±0.6)points after treatment,indicating the statistical difference in comparison before and after treatment(P<0.05).Conclusion:The sitting-pushing manipulation combined with acupuncture at GB34 and bloodletting at BL 40 achieves a very satisfactory therapeutic effect on thoracic facet joint disorder syndrome.Such combined therapy is a kind of favorable method for thoracic facet joint disorder syndrome.

经穴位至关节突注射臭氧水配合推拿、针刺对关节突源性腰痛的影响

目的:观察经穴位至关节突注射臭氧水配合推拿、针刺治疗关节突源性腰痛的临床效果。方法:前瞻性选取河南中医药大学第三附属医院收治的符合纳入标准的106例关节突源性腰痛患者为研究对象,依据随机数字表随机分为研究组53例和对照组53例。对照组接受推拿、针刺治疗,研究组接受经穴位至关节突注射臭氧水配合推拿、针刺治疗,均治疗3个疗程。比较两组疗效、不良反应与复发率,以及治疗不同时间点疼痛程度(VAS评分)、腰椎功能障碍评分(ODI评分)和生活质量评价量表评分(SF-36评分)差异。结果:治疗后,两组临床疗效比较差异有统计学意义(Z=2.572,P<0.05),研究组总优良率88.68%(47/53)高于对照组71.7%(38/53),复发率7.55%(4/53)低于对照组22.64%(12/53)(P<0.05)。两组VAS评分和ODI评分的时点效应、组间效应、交互效应比较,差异有统计学意义(P<0.05),两组治疗1个疗程后、治疗3个疗程后VAS评分和ODI评分均低于治疗前(P<0.05),且研究组治疗1个疗程后、治疗3个疗程后VAS评分和ODI评分均低于对照组(P<0.01)。治疗期间两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。两组治疗后生活质量评价量表(SF-36)各维度得分(躯体疼痛、社会功能、精神健康、生理职能、情感职能、生理功能、精力)均高于治疗前(P<0.05),且研究组治疗3个疗程后SF-36量表各项得分均高于对照组(P<0.05)。结论:经穴位至关节突注射臭氧水配合推拿、针刺治疗关节突源性腰痛具有较好临床疗效,可有效降低复发率,改善疼痛程度与腰椎功能障碍,提高生活质量,且安全性较好。

MR T2^(*)mapping成像技术定量评价腰椎小关节炎软骨损伤

背景:腰椎小关节炎是引起下腰痛的一个主要原因,目前主要依靠MRI进行初步定性诊断,但仍有一定漏诊、误诊的概率发生,因此MR T2^(*)mapping成像技术有望成为定量检查腰椎小关节炎软骨损伤的重要检测手段。目的:探讨MR T2^(*)mapping成像技术在定量分析腰椎小关节炎软骨损伤退变中的应用价值。方法:收集南京医科大学第四附属医院2020年4月至2022年3月门诊或住院合并下腰痛共110例患者,设为病例组;同时招募无症状志愿者80例,设为对照组。对所有纳入对象L1-S1的小关节行3.0 T MR扫描,获取T2^(*)mapping横断位图像和T2WI图像,分别对所有小关节软骨进行Weishaupt分级及T2^(*)值测量,收集数据并行统计学分析。不同小关节Weishaupt分级之间小关节软骨T2^(*)值比较采用单因素方差分析。结果与结论:①经统计分析发现,病例组腰椎小关节软骨T2^(*)值(17.6±1.5)ms明显较对照组(21.4±1.3)ms降低,差异有显著性意义(P<0.05);②在病例组中,随着腰椎小关节Weishaupt分级增加,小关节软骨T2^(*)值也呈逐渐下降趋势,且这种差异有显著性意义(P<0.05);③提示T2^(*)mapping能够较好地显示腰椎小关节软骨损伤的早期病理变化,腰椎小关节软骨的T2^(*)值能够定量评估腰椎小关节的软骨损伤程度;T2^(*)mapping成像技术能为影像学诊断腰椎小关节炎软骨早期损伤提供很好的理论依据,具有重要的临床应用价值。

中西医结合治疗腰椎小关节骨关节炎临床观察

目的 外搽舒活酒外贴伤科止痛膏联合口服盐酸氨基葡萄糖配合运动治疗腰椎小关节骨关节炎的临床疗效观察。方法 选择145例腰椎小关节骨关节炎患者,随机分为试验组73例、对照组72例。对照组予红外线照射、电针、外贴膏药治疗,观察组在对照组的基础上增加外搽舒活酒外贴伤科止痛膏联合口服盐酸氨基葡萄糖片配合运动治疗;对比分析治疗前、治疗后6周、治疗后12周、治疗周期结束后3个月的CDTY评分及临床疗效。结果 治疗周期结束后3个月,试验组的CDTY评分、痊愈率、显效率均优于对照组(P<0.05)。结论 外搽舒活酒外贴伤科止痛膏联合口服盐酸氨基葡萄糖配合运动治疗腰椎小关节骨关节炎能明显改善症状,且远期疗效明显,值得临床推广。

基于CT观察退变性腰椎滑脱症与关节突关节角及关节椎弓根角的关系

目的:基于CT观察探讨退变性腰椎滑脱(DLS)与关节突关节角和关节椎弓根角的关系。方法:回顾性收集2020年1月至2022年6月四川省骨科医院收治的169例DLS症患者纳为DLS组,另选取同期于我院体检并伴有腰腿疼痛但未腰椎滑脱的169例年龄匹配患者作为健康组;对比DLS组和健康组的临床资料,单因素以及多因素logistic回归分析影响DLS的危险因素;通过平滑曲线拟合分析关节突关节角和关节椎弓根角与DLS的曲线关系,构建贝叶斯网络模型并对其预测效能进行验证。结果:单因素分析结果显示DLS组在BMI、椎间盘退变、全身关节松弛、腰椎结构及曲度发生改变、韧带松弛、骨质疏松、脱钙、腰椎小关节突病变、合并糖尿病方面均高于健康组(P<0.05);DLS组的关节突关节角与健康组相比减小,关节突关节角不对称以及退变程度为1、2级的人数比例上升,椎弓根角显著增大(P<0.05);多因素分析结果表明BMI增加、椎间盘退变、腰椎结构及曲度发生改变、韧带松弛、骨质疏松、脱钙、全身关节松弛、腰椎小关节突病变、合并糖尿病、关节突关节角减小、关节突关节角不对称、关节突关节的退变以及椎弓根角的增加都是导致DLS发生的危险因素(OR值>1,P<0.05);平滑曲线拟合结果显示,在一定范围内,关节椎弓根角与DLS呈正相关,而关节突关节角和与DLS呈负相关;贝叶斯网络模型及预测推理显示:BMI指数增加、关节突关节角减小、关节突关节角不对称以及椎弓根角的增加与DLS直接相关,当患者关节突关节角减小、关节突关节角不对称以及椎弓根角的增加的概率降为0时,患者DLS发生率由50%降低为37.2%;经过模型验证证明贝叶斯网络预测模型具有良好的区分度、准确度和有效性。结论:基于CT观察可以对DLS有更准确的诊断,且在一定范围内关节突关节角和关节椎弓根角与DLS具有一定的相关性。

基于红外线热成像技术探索“按之则热气至”的按压次数-热效应机制研究

背景推拿量效关系的客观测量方法越来越多,但将红外线热成像技术与推拿量效关系结合的研究较少。目的通过对比不同的叠掌按压法次数(3、5、7次)下治疗区域温度值、肌张力、压痛阈值变化,为红外线热成像技术运用于推拿量效关系提供依据。方法于2021-06-17—12-24在广东省中医院大德路总院推拿科招募18例胸椎小关节紊乱(病变节段在T3~T4)患者。将患者分为按压7次组(n=6)、按压5次组(n=6)、按压3次组(n=6),接受叠掌按压法治疗,次数分别为7、5、3次。采用红外线热成像仪获取患者全身的红外热像图,提取病变区域的平均温度值;运用软组织张力测试分析系统测量病变胸椎处旁竖脊肌的肌张力;运用痛阈测定仪测量病变胸椎棘突旁体表部位的压痛阈值。结果按压3次组干预后的T3棘突右旁开0.5寸(T3 R)温度值及T4棘突右旁开0.5寸(T4 R)温度值均低于干预前(P<0.05)。干预后,三组T3棘突左旁开0.5寸(T3 L)在0.2 kg的力下肌张力、T3 R在0.2 kg的力下肌张力、T4棘突左旁开0.5寸(T4 L)在0.2 kg的力下肌张力、T4 L在0.5 kg的力下肌张力、T4 L在0.8 kg的力下肌张力、T4 R在0.2 kg的力下肌张力、T4 R在0.5 kg的力下肌张力比较,差异均有统计学意义(P<0.05)。按压7次组干预后T3 R在0.2、0.5 kg的力下肌张力高于干预前(P<0.05)。按压3次组干预后T3 L、T3 R、T4 L、T4 R压痛阈值低于干预前(P<0.05)。按压7次组干预后T3 L、T3 R压痛阈值低于干预前(P<0.05)。三组患者在接受治疗时均未出现不良事件。结论按压次数较少可能产生较好的疗效。红外线热成像技术作为推拿量效关系的测量方式仍需要进一步研究。结合本研究的问题可进一步为红外线热成像与推拿的关系提供研究思路。