颈椎"挥鞭样"损伤对Facet关节倾角的影响  

Influence of cervical whiplash injury on facet joint angle

作　　者：张敏[1] 王玉强[1] 刘屹林[1] 宋瑞鹏[1] 赵耀[1] 张书豪[1] 赵亮[1] 杨浩[1] 朱忠培[1] 张扬 王利民[1] Zhang Min;Wang Yuqiang;Liu Yilin;Song Ruipeng;Zhao Yao;Zhang Shuhao;Zhao Liang;Yang Hao;Zhu Zhongpei;Zhang Yang;Wang Limin(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2020年第12期2332-2336,共5页Chinese Journal of Experimental Surgery

摘　　要：目的探讨无骨折脱位型颈椎"挥鞭样"损伤(WAD)对损伤节段及邻近节段关节突(Facet)关节倾角的影响。方法2017年8月到2019年12月在郑州大学第一附属医院骨科门诊或急诊就诊的因WAD所致的颈(C)5/6椎间盘突出症患者40例(排除颈椎骨折脱位),选取同期以颈部不适就诊的非颈椎病患者40例,分为外伤组和对照组。测量所有患者C4~C7的Facet关节倾角,并对C4~C7椎间盘退变和关节突退变的分级进行统计分析。采用重复测量的方差分析、秩和检验、t检验和χ^2检验等。结果重复测量数据的方差分析结果表明:C4~C7每个颈椎Facet关节倾角在两组内椎间比较差异有统计学意义(F椎间=45.630,P椎间<0.05),角度大小依次均为C5<C6<C4<C7;外伤组与对照组的Facet关节倾角组间差异有统计学意义(F组间=5.206,P组间<0.05)。具体分析显示:外伤组C5、C6椎体Facet关节倾角与对照组比较减小,差异有统计学意义(FC5=10.257,FC6=4.910,PC5及PC6<0.05),外伤组C4椎体Facet关节倾角与对照组比较有减小趋势(FC4=0.070,PC4>0.05),外伤组C7椎体Facet关节倾角与对照组比较有增大趋势(FC7=0.084,PC7>0.05),但差异均无统计学意义(P>0.05);Mann-Whitney U秩和检验显示:外伤组C5/6椎间盘的退变与对照组比较更为严重(UC5/6=12,P<0.05);外伤组C4~C7关节突关节的退变与对照组比较程度相当(UC4/5=720,UC5/6=740,UC6/7=760,P>0.05);Kendall’s tau-b秩相关分析表明:外伤组C5椎体Facet关节倾角与C5/6椎间盘退变程度呈负相关(rs=-0.842,P<0.05)。结论WAD将导致损伤节段的上下椎体的Facet关节倾角变小,引起损伤节段的稳定性下降,而对邻近节段的Facet关节倾角影响不大;WAD可能即刻加重了损伤节段的椎间盘退变,而对关节突关节退变的影响尚需长时间的随访来进一步确定。Objective To investigate the influence of cervical whiplash-associated disorders(WAD)on the joint angle of the articular process(Facet)in the injured segment and adjacent segments.Methods 40 cases of patients with cervical(C)5/6 intervertebral disc herniation caused by WAD in outpatient or emergency department(patients with fracture and dislocation of cervical spine were excluded).40 cases who were not cervical spondylosis patients with neck discomfort were collected together.They were divided into trauma group and control group.Imaging data of all patients were analyzed.The angle of C4-C7 Facet joint was measured.And grades of degeneration of intervertebral disc and articular process of C4-C7 were analysed.Results Analysis of variance for repeated measurements for two groups showed that:There were statistically significant differences in the 2 groups in each angle of the C4-C7 cervical spine Facet joint(C5<C6<C4<C7).The difference was statistically significant(Fintervertebral=45.630,Pintervertebral<0.05).There were differences in Facet joint angle between the trauma group and the control group(Fgroup=5.206,Pgroup<0.05).The C5/C6 Facet joint angle of the trauma group was less than that of the control group.The difference was statistically significant(FC5=10.257,FC6=4.910,P<0.05).There is a decreasing trend in the C4 joint angle.But the difference was not statistically significant(FC4=0.070,PC4>0.05).There is an increasing trend in the C7 joint angle.But the difference was not statistically significant(FC7=0.084,PC7>0.05).Mann-Whitney U rank sum test shows:Compared with the control group,the C5/6 intervertebral disc degeneration in the trauma group was more severe than that in the control group.The difference was statistically significant(UC5/6=12,P<0.05).The degeneration of C4-C7 joint of trauma group was the same as that of the control group,the difference was not statistically significant(UC4/5=720,UC5/6=740,UC6/7=760,P>0.05).Kendall’s tau-b rank correlation analysis showed that:The C5 vertebral Facet joint i

关 键 词："挥鞭样"损伤 小关节 椎间盘退变 稳定性 

分 类 号：R681.5[医药卫生—骨科学]