腰椎MRI评价椎间小关节积液与退变性腰椎滑脱稳定性的相关性  

Correlation between facet joint effusion in magnetic resonance imaging and lumbar stability after interspinous and degenerative lumbar spondylolisthesis

作　　者：马钧峰 汪伟 王紫括 江泽华[2] 龙明星 袁建军[2] 朱如森[2] 胡炜[2] 张学利[2] Ma Junfeng;Wang Wei;Wang Zikuo;Jiang Zehua;Long Mingxing;Yuan Jianjun;Zhu Rusen;Hu Wei;Zhang Xueli(Graduate School, Tianjin Medical University, Tianjin 300070, China;Department of Spinal Surgery, Tianjin People’s Hospital, Tianjin 300121, China;Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China)

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市人民医院脊柱外科,天津市300121 [3]河南省人民医院,河南省郑州市450003

出　　处：《中国组织工程研究》2019年第24期3846-3851,共6页Chinese Journal of Tissue Engineering Research

基　　金：天津市卫生计生委科技基金(16KG158);项目负责人:朱如森~~

摘　　要：背景:临床中对腰椎滑脱患者腰椎稳定性的诊断多借助腰椎侧位屈伸X射线,但该检查存在一定的局限,因此寻找可靠的腰椎稳定性预测指标十分必要。目的:通过回顾患者影像学资料,分析退变性腰椎滑脱患者腰椎椎间小关节积液是否与腰椎稳定性存在相关性。方法:回顾性分析2016年12月至2018年1月在天津市人民医院脊柱外科就诊的L4-5节段腰椎退变性滑脱患者共108例,所有患者对测量方案知情同意,且得到医院伦理委员会批准。根据其滑脱节段的腰椎MRI中是否出现椎间小关节腔内积液将患者分为无积液组55例,有积液组53例,并对2组进行对比分析。对有积液组中的双侧椎间小关节积液宽度和与矢状位椎体动态滑移指数、椎体旋转度、双侧椎间小关节退变指数和及椎间盘退变指数分别进行相关性分析。结果与结论:①无积液组的失稳率低于有积液组,动态滑移量、动态滑移指数及矢状位旋转度均小于有积液组,椎间小关节及椎间盘退变程度均高于有积液组,差异均有显著性意义(P=0.000);②对于有积液组的相关性分析,双侧椎间小关节积液宽度和分别与矢状位椎体动态滑移指数、矢状位椎体旋转度成线性正相关(r=0.710,P=0.000;r=0.452,P=0.001);双侧椎间小关节积液宽度和分别与双侧椎间小关节退变指数和、椎间盘退变指数成负相关(r=-0.630,P=0.000;r=-0.648,P=0.000);③提示退变性腰椎滑脱症患者腰椎MRI上存在椎间小关节积液表现可提示滑脱不稳定,滑脱节段椎间小关节总积液量与腰椎滑移不稳定性、旋转不稳定性成正相关,与双侧椎间小关节退变程度、椎间盘退变程度成负相关。BACKGROUND: Clinically, the diagnosis of lumbar spine stability in patients with lumbar spondylolisthesis is mostly based on lumbar lateral flexion and extension X-ray, but this examination has certain limitations, so it is necessary to find a reliable predictor of lumbar stability. OBJECTIVE: To evaluate the correlation between facet joint effusion and lumbar stability after interspinous and degenerative lumbar spondylolisthesis by retrospectively analyzing patients’ imaging data. METHODS: A total of 108 patients with L4-5 lumbar spondylolisthesis in Department of Spinal Surgery, Tianjin People’s Hospital from December 2016 to January 2018 were analyzed retrospectively. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into non-effusion group (n=55) and effusion group (n=53) according to the presence and absence of intra-articular effusion of intervertebral facet joint based on lumbar MRI. The two groups were comparatively analyzed. In the effusion group, the correlation between the effusion width of bilateral facet joint and the dynamic slip index of sagittal vertebra, the rotation degree of sagittal vertebral body, bilateral degeneration index of facet joint, intervertebral disc degeneration index were statistically analyzed separately. RESULTS AND CONCLUSION:(1) Compared with the effusion group, the instability rate was lower;the dynamic slip volume, dynamic slip index, and the sagittal rotation degree were less;and the degeneration degree of facet joint and intervertebral disc was higher in the non-effusion group (P=0.000).(2) There was a linear positive correlation between the width of effusion of bilateral facet joints and the dynamic slip index of the sagittal vertebral body, the rotation degree of the sagittal vertebral body in the effusion group ( r=0.710, P=0.000;r=0.452, P=0.001). There was a linear negative correlation between the width of effusion of bilateral facet joints and the degeneration index of bilateral facet jo

关 键 词：椎间小关节积液 腰椎MRI 腰椎滑脱 腰椎稳定性 椎间盘退变 相关性分析 

分 类 号：R459.9[医药卫生—治疗学] R445.2[医药卫生—临床医学]