CT测量椎小关节头尾侧趋向性变化在退行性腰椎滑脱诊断中的价值分析  

The cephalad to caudad trend of the facet joint in the diagnosis of degenerative lumbar spondylolisthesis by CT

作　　者：葛卫卫[1] 邹月芬[1] 

机构地区：[1]南京医科大学第一附属医院影像科,江苏南京210029

出　　处：《实用放射学杂志》2014年第3期474-477,共4页Journal of Practical Radiology

摘　　要：目的研究椎小关节头尾侧趋势性变化和退行性腰椎滑脱（degenerativelumbarspondylolisthes沁DLS）及椎小关节退行性变之间的关系。方法60例L4椎体滑脱患者为滑脱组（DS组），60例同期无滑脱的患者为小关节退变组（DG组）。均采用CT扫描，测量2组L3～L4、L4～L5节段头尾侧小关节角并进行比较分析，同时观察DS组关节突关节退变程度。结果DS组2个节段头尾侧小关节角之间均有显著差异（P〈0．01）；ITkS组和IX；组各节段小关节角进行对比均有显著统计学差异（P〈0．01），且DS组较DG组小关节角明显偏大；DS组L3～L4节段和L4-L5节段头侧小关节角，经配对t检验分析，具有显著统计学差异（P〈0．01），说明I）S组滑脱节段及相邻节段的头侧小关节均表现出一种矢状化的趋势。结论头侧小关节角更能体现退行性腰椎滑脱患者小关节的矢状趋向上的变化。小关节头侧的矢状面趋向性以及小关节尾侧的冠状面趋向性是退行性腰椎滑脱的病因学因素。Objective To study the cephalad to eaudad trend of the facet joint and the relationship between degenerative lumbar spondylolisthcsis（DI.S）and facet joint degeneration. Methods 60 patients suffering DLS at L4 were reviewed as DS group, and 60 cases without DI.S were selected as DG group. Both groups received CT scanning. The cephalad and caudad portion of facet angle at 1.3 -- 1.4 and 1.4 - 1.5 was measured and compared, and facet joint degeneration was also evaluated. Results In DS group, both L3-1.4 and 1.4-1.5 segment showed significant differences between the eephalad and caudad portion of facet angle （P〈0. 01）; when compared each segment between DS group and DG group, the facet angle of DS group was significantly bigger than that of DG group （P〈0.01）. In DS group, there was a significant difference between the facet angles of cephalad portion, but not caudad portion, of L3-L4 and L4--L5 segment by matching t test, respectively （P〈0.01）. It indicated that the cephalad portion of the facet joint in the slide segment and adjacent segment was more sagittally oriented. Conclusion The cephalad portion of facet angle was more sagit tally oriented in patients with I）I.S while the caudad portion was more coronally oriented. Our study may suggest that the cephalad portion of facet angle was an important etiological factor of degenerative lumbar spondylolisthesis.

关 键 词：退行性腰椎滑脱 小关节趋向性 小关节角 小关节退变 

分 类 号：R681.5[医药卫生—骨科学] R684[医药卫生—外科学]