摘要
[目的]通过CT图像多层重建技术研究关节突关节方向的空间变化在退变性腰椎滑脱发生中的病因学意义。[方法]滑脱组:L4、5退变性腰椎滑脱患者,30例;对照组:同期年龄、性别相匹配的无脊柱滑脱和腰腿疼的其他患者,30例。分别选取平行于L3、4和L4、5椎间隙上、下缘终板的关节突关节CT图像,测量头、尾侧关节突关节方向与椎体矢状面夹角,并对CT图像上头、尾侧关节突关节退变程度进行评估分级;重建关节突关节面二维矢状面CT图像,测量椎弓根轴线与关节突关节间隙之间角度。[结果]滑脱组组内比较L4、5节段头、尾侧关节突关节角均较L3、4节段头、尾侧关节突关节角小,L3、4、L4、5节段头侧关节突关节角较尾侧关节突关节角小,均有统计学意义(P<0.05),而在对照组则相反。组间比较,在L3、4和L4、5节段,滑脱组头、尾侧关节突关节角均较对照组小(P<0.05),且滑脱组头、尾侧关节突关节角改变的差值较对照组大(P<0.05)。两组在L4、5节段头侧和尾侧关节突关节角的不对称性较L3、4节段的头侧和尾侧更加明显(P<0.05)。滑脱组L3、4、L4、5椎弓根-关节突关节角均较对照组大(P<0.05)。在L4、5节段关节突关节退变程度比较中,两组头、尾侧退变程度均差异明显(P<0.05),而在L3、4节段的退变程度差异不明显。[结论]关节突关节空间方向的改变对退变性腰椎滑脱的发生具有病因学意义,而关节突关节退变则是一种继发性改变。
[ Objective] To study the etiologic effect of the spatial change of facet joint orientation in the occurrence of degenerative lumbar spondylolisthesis by using muhislice computed tomography （CT） with muhiplanar reformation techniques. [ Methods ] In the present study, we examined 2 groups of patients. The research group consisted of 30 patients with degenerative lumbar spondylolisthesis that was present only at the L4,5 level. The control groupconsisted of 30 patients who had back pain without degenerative lumbar spondylolisthesis. The patients in both groups were matched with respect to age and gender. All the patients underwent CT scans of the facet joint parallel to the superior and inferior endplate at the L3,4 and L4,s levels, respectively. The angle between the facet joint and vertebral sagittal plane on the cephalic and caudal portion was measured, and the grade of facet joint degeneration on the cephalic and caudal portion was evaluated accordingly. The two - dimensional sagittal CT image of the facet jointswas reconstructed, and the pedicle - facet joint angle between the pedicle axis and the facet joint gap was measured. [ Results ] Comparisons within the research group indicated that the facet angles of the cephalic and caudal portions at the L4,5 level were lesser than those at the L3,4 level, and the cephalic facet angles were less than the caudal angles at both the L3,4 and L4,5 levels. Although these values were significantly different in the research group （ P 〈 0.05）, no significant difference was noted in these values in the control group. On comparison between both groups, the facet angles of the cephalic and caudal portion were lesser in the research group than those in the control group at the L4,5 and L3,4 levels （ P 〈 0. 05） . In addition, thedifference in the facet angle between the cephalic and caudal portions was greater in the research group as compared to the control group at the L3,4 and L4,5 levels （P 〈 0. 05） . The asymmetry of the cephalic and caudal facet angles at the L4,5 level in both the groups was more apparent than that at the L3.4 level （ P 〈 0. 05）. The pedicle - facet joint angles were significantly greater in the research group than in the control group at both L3、4 and L4,5 levels （P 〈 0. 05） . On comparing the grade of facet joint degeneration on the cephalic and caudal portion between the 2 groups, there were statistically significant differences at the L4,5 level （ P 〈 0. 05 ）, whereas there was no significant difference at the L3,4 level. [ Conclusion] The change of spatial orientation in the facet joint is an etiological factor of degenerative lumbar spondylolisthesis, whereas facet joint degeneration is a secondary change.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第21期2127-2132,共6页
Orthopedic Journal of China
基金
安徽医科大学附属省立医院杰出技术骨干专项基金(编号:2012204)
关键词
关节突方向
腰椎
退变性滑脱
CT
多层面重建
facet orientation, lumbar spine, degenerative spondylolisthesis, computed tomography, muhiplanar reformation
