关节突关节角度与退行性腰椎滑脱的关系

Relationship between orientation of lumbar facet and degenerative lumbar spondylolisthesis

中文关键词:  脊椎滑脱  退变  腰椎  关节突关节

英文关键词:Spondylolisthesis  Degeneration  Lumbar vertebrae  Facet joint

中文摘要:

  【摘要】 目的：探讨关节突关节角度与退行性腰椎滑脱（DLS）的关系。方法：选取2008年7月~2010年6月我院收治的60例单纯退行性L4/5节段前滑脱患者为DLS组，年龄55.6±8.8岁，排除腰椎骨折及峡部不连者；对照组为57例同期无滑脱及腰腿痛的其他疾病患者，年龄53.7±9.4岁。两组均行腰椎CT检查，在CT定位像上测量DLS组患者L4/5节段滑移距离及下位椎体矢状径，计算腰椎滑脱程度（Taillard指数）；在CT图像上测量两组L3/4、L4/5及L5/S1节段关节突关节角并进行比较分析；骨窗条件下观察DLS组L4/5关节突关节退变程度，按Fujiwara标准进行分级，并按不同退变等级分3组比较滑脱程度；对DLS组L4/5的关节突关节角与滑脱程度进行直线相关性分析。结果：DLS组L4/5均为Ⅰ度滑脱，Taillard指数为0.1679±0.0365。DLS组L4/5关节突关节角为33.1°±12.2°，小于对照组的49.5°±11.4°，差异有显著性（P<0.001）；DLS组与对照组L3/4关节突关节角分别为36.1°±9.1°与38.6°±8.0°，无显著性差异（P＞0.05）；DLS组与对照组L5/S1关节突关节角分别为48.5°±13.0°与51.9°±13.0°，无显著性差异（P＞0.05）。DLS组L4/5滑脱Taillard指数与其关节突关节角度无相关性（r=0.065，P＞0.05）。DLS组患者L4/5关节突关节退变程度为Ⅱ度4例，Ⅲ度23例，Ⅳ度33例，其滑脱Taillard指数分别为0.1837±0.0418、0.1723±0.0370和0.1589±0.0343，各组间滑脱程度差异无显著性（P＞0.05）。结论：DLS患者滑脱节段的关节突关节角明显小于非滑脱患者的相应节段，但关节突关节角度与DLS的关系尚不明确。

英文摘要:

  【Abstract】 Objective：To investigate the relationship between the orientation of lumbar facet and degenerative lumbar spondylolisthesis（DLS）.Method：From July 2008 to June 2010，60 patients（average age：55.6±8.8 years）suffering DLS at L4/5 were reviewed retrospectively，those with lumbar fracture and spondylolysis were excluded in this study；while 57 cases（average age：53.7±9.4 years） without DLS and low back pain were selected as control group.Both 2 groups received lumbar CT scanning，the displacement of L4 and sagittal diameter of L5 in DLS group were measured on CT scan，the degree of spondylolisthesis（Taillard index） was calculated；the orientation of facet at L3/4，L4/5 and L5/S1 of both groups was measured from CT image and compared. L4/5 facet joint degeneration was evaluated.According to Fujiwara standard in bone window，the degree of spondylolisthesis（Taillard index） of the L4/5 at different degenerative grade of facet joint was compared，and the correlation between L4/5 facet joint orientation and degree of spondylolisthesis（Taillard index） were ana?鄄lyzed.Result：All L4/5 spondylolisthesis in DLS group were gradeⅠ，with the average Taillard index of 0.1679±0.0365，the angle of the facet joint of L4/5 was less than control group（33.1°±12.2° vs 49.5°±11.4°，P<0.001），but no significant difference with respect to L3/4 and L5/S1 between both groups（36.1°±9.1° vs 38.6°±8.0°，48.5°±13.0° vs 51.9°±13.0° respectively，P＞0.05） were noted.In DLS group，no relationship between degree of spondylolisthesis（Taillard index）and the orientation of the L4/5 facet joint was noted（r=0.065，P＞0.05）.As for L4/5 facet joint degeneration in DLS group，there were 4 grade Ⅱ，23 grade Ⅲ and 33 grade Ⅳ，with the Taillard index of 0.1837±0.0418，0.1723±0.0370 and 0.1589±0.0343 respectively，which showed no significant difference among each grade（P＞0.05）.Conclusion：For DLS patient，the angle of facet joint at slipping level in section is less than the same section of patients without spondylolisthesis，but the relationship between facet joint angel and DLS remains unclear.