腰椎小关节骨性关节炎与小关节角度及不对称性的关系  

Relationships between the severity of lumbar spine facet joint osteoarthritis,facet orientation and facet tropism

作　　者：程若勤[1] 程小杰[1] 

机构地区：[1]武汉科技大学附属天佑医院,武汉430064

出　　处：《现代仪器与医疗》2013年第2期28-31,27,共5页Modern Instruments & Medical Treatment

摘　　要：目的 探讨下腰椎小关节骨性关节炎（facet joint osteoarthritis, FJOA）严重程度与小关节角度及小关节不对称性之间的关系。方法 回顾性分析97例50-80岁腰腿痛患者的多层螺旋CT（MSCT）资料，评定L3/4、L4/5、L5/S1水平两侧的FJOA等级，共分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级，再分为FJOAⅠ-Ⅱ级组和 FJOA Ⅲ-Ⅳ级组。根据两侧FJOA程度是否对称分为FJOA对称组（两侧均为FJOAⅠ-Ⅱ级或两侧均为 FJOA Ⅲ-Ⅳ）和FJOA不对称组（一侧为FJOAⅠ-Ⅱ级，另一侧为FJOA Ⅲ-Ⅳ）。在 MSCT 轴位骨窗上测量、比较两侧小关节角，评价两侧FJOA等级与小关节角及小关节不对称性的关系。结果 97例患者中，L3/4、L4/5、L5/S1水平两侧FJOA严重程度不对称分别为29（29.9%）、21（21.6%）、25（25.8%）例，各水平间FJOA不对称所占百分比无统计学差异（P均＞0.05）。在FJOA不对称组，L4/5、L5/S1水平两侧小关节角存在统计学差异（PL4/5=0.011和PL5/S1=0.029）。在FJOA不对称组，L5/S1水平上小关节不对称百分比为83.1%，与FJOA对称组同水平相比具有统计学差异（PL5/S1=0.001）；在L3/4、L4/5水平，小关节不对称百分比在FJOA对称组与不对称组间无统计学差异（PL3/4 ，PL4/5均＞0.05）。在FJOA对称组，在L4/5、L5/S1水平上，小关节不对称百分比在两侧均为FJOA Ⅲ-Ⅳ级组高于两侧均为FJOAⅠ-Ⅱ级组，两者存在统计学差异（PL4/5=0.046，PL5/S1=0.022）。 结论 老年患者下腰椎MSCT影像中常可发现两侧FJOA严重程度不对称的现象。FJOA程度越重，小关节角越大，关节面越倾向矢状面；两侧FJOA程度不对称时两侧小关节不对称的发生率较高，且随小关节骨性关节炎程度的加重小关节不对称的发生率增高。Objective To investigate the relationships between the ？severity？of facet joint osteoarthritis （FJOA） at lower lumbar spine, facet orientation and facet tropism. Methods The MSCT axial images of 97 patients aged 50-80 years with lumbocrural pain were reviewed retrospectively. The grades of bilateral FJOA were evaluated using 4-grade scale on MSCT images at the L3/4, L4/5 and L5/S1 levels. Then they were divided into mild group （FJOAⅠ-Ⅱ） and serious group （FJOA Ⅲ-Ⅳ）. According to the symmetry of bilateral FJOA in each facet joint, all subjects were divided into two groups： symmetric FJOA group （FJOA Ⅰ-Ⅱ on both sides or FJOA Ⅲ-Ⅳ on both sides） and asymmetric FJOA group （FJOA Ⅰ-Ⅱ on one side and FJOA Ⅲ-Ⅳ on the other side）. The bilateral facet joint angle were measured and compared on MSCT axial images, the associations of FJOA to facet orientation and facet tropism were evaluated. Results In the 97 patients, asymmetric FJOA was 29（29.9%）, 21（21.6%）, and 25（25.8%）at the levels of L3/4, L4/5, and L5/S1, respectively. There was no significant difference in prevalence of asymmetric FJOA at each level （P〉0.05）. Asymmetric FJOA showed significant difference in facet orientation between two sides at the L4/5 （P=0.011） and L5/S1 levels （P=0.029）. Compared with symmetric FJOA, asymmetric FJOA showed significant difference in prevalence of facet tropism （83.1%） at the L5/S1 level （P=0.001）, but had no significant difference in prevalence of facet tropism at L3/4 and L4/5 levels （P〉0.05）. Symmetric FJOA showed significant difference in prevalence of facet tropism between two sides FJOA Ⅲ-Ⅳ and two sides FJOA Ⅰ-Ⅱ at the L4/5 and L5/S1 levels （PL4/5=0.046, PL5/S1=0.022）, prevalence of facet tropism in two sides FJOA Ⅲ-Ⅳ was higher than in two sides FJOA Ⅰ-Ⅱ. Conclusion In the elderly patients, asymmetric FJOA usually appears on MSCT images for lower lumbar spine. With the FJOA degree more serious, the facet orient

关 键 词：腰椎 小关节骨性关节炎 小关节角 小关节不对称 X线计算机 

分 类 号：R445[医药卫生—影像医学与核医学]