关节突关节形态在有无合并退行性滑脱的腰椎管狭窄症患者中的差异性研究  

The difference of facet joint morphology in lumbar spinal stenosis with or without degenerative spondylolisthesis

作　　者：高泽 李凯[2] 薛旭红 王世雄[1] 张艳东 栗远威 席凡辉 GAO Ze;LI Kai;XUE Xu-hong;WANG Shi-xiong;ZHANG Yan-dong;LI Yuan-wei;XI Fan-hui(Shanxi Medical University,Taiyuan,Shanxi,030101,China)

机构地区：[1]山西医科大学,太原030101 [2]山西医科大学第二医院骨科,太原030001

出　　处：《中国骨与关节杂志》2024年第3期209-218,共10页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(82272575);山西省自然科学基金面上项目(202203021211041)。

摘　　要：目的 探讨关节突关节形态在有无合并退行性滑脱的腰椎管狭窄症(lumbar spinal stenosis,LSS)患者中的差异。方法 回顾分析2021年8月至2022年10月我院收治的80例伴有退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的LSS患者的临床资料,其中60例L_(4~5)节段滑脱患者为DLS-a组、20例L_(5)~S_(1)节段滑脱患者为DLS-b组。另外收集同期收治的80例单纯退行性LSS患者的临床资料,其中66例L_(4~5)节段狭窄患者为LSS-a组,14例L_(5)~S_(1)节段狭窄患者为LSS-b组。四组患者均行腰椎CT检查,计算腰椎滑脱程度(Taillard指数);多平面重建技术测量L_(4~5)及L_(5)~S_(1)节段关节突关节角(facet joint angle,FJA)、关节突-椎弓根角(pedicle-facet angle,P-FA)以及关节突关节向性(facet tropism,FT)并进行比较分析;对测量所得的FJA与滑脱程度进行直线相关性分析;同等窗宽窗位条件下观察DLS组和LSS组L_(4~5)、L_(5)~S_(1)关节突关节退变程度,按Kalichman L标准进行分级并比较分析。结果 DLS组多为I度或Ⅱ度滑脱,且女性患者多见。DLS-a组L_(4~5)的FJA (30.87±8.82)°、P-FA (119.10±5.93)°与LSS-a组(42.58±9.39)°、(109.94±6.77)°相比,差异均有统计学意义(P<0.05);DLS组其Taillard指数与P-FA有相关性(P<0.05);具有FT的病例占DLS组(47/58.75%)、LSS组(36/45.00%),对比差异有统计学意义(P>0.05);DLS组与LSS组FT严重程度均与其FJA、P-FA、Taillard指数均无明显相关性(P>0.05)。关节突关节退变程度在DLS组与LSS组有显著差异(P<0.05);DLS-a组关节突关节退变程度与P-FA及Taillard指数有显著相关性(P<0.05)。结论 FJA在有无合并退行性滑脱的LSS患者中有显著差异。DLS患者较LSS患者责任节段具有更小的FJA,更大的P-FA,即DLS患者较LSS患者的FJ更趋于矢状化和水平化;Taillard指数和P-FA有线性关系,P-FA角越大,其Taillard指数越大;DLS组较LSS组相比更容易出现FT,且FT越严重,关节突关节退变越严重。Objective To investigate the difference of facet joint morphology in lumbar spinal stenosis patients with or without degenerative spondylolisthesis.Methods The clinical data of 80 patients with degenerative lumbar spondylolisthesis(DLS)treated in our hospital from August 2021 to October 2022 were retrospectively analyzed.Among them,60 patients with L_(4-5) spondylolisthesis were classified as DLS-a group and 20 patients with L_(5)-S_(1) spondylolisthesis were classified as DLS-b group.In addition,the clinical data of 80 patients with simple degenerative spinal stenosis(LSS)treated in the same period were collected.66 patients with L_(4-5) stenosis were classified as LSS-a group,and 14 patients with L_(5)-S_(1) stenosis were classified as LSS-b group.Lumbar spondylolisthesis(Taillard index)was calculated by CT in all four groups.The articular angle,articulation-pedicle angle and articular facet orientation of L_(4-5) and L_(5)-S_(1) segments were measured and compared by multi-plane reconstruction technique.The linear correlation between the angle of the facet joint and the degree of slip was analyzed.The degree of L_(4-5) and L_(5)-S_(1) facet joint degeneration in DLS group and LSS group were observed under the same window width and position,graded and compared according to Kalichman L standard.Results The DLS group mostly had gradeⅠorⅡspondylolisthesis,and female patients were more common.There were significant differences in L_(4-5) FJA and P-FA in DLS group compared with LSS group(P<0.05).The Taillard index in DLS group was correlated with P-FA(P<0.05).There was a significant difference between DLS group(47/58.75%)and LSS group(36/45.00%)in the number of cases with facet arthrotropism(FT)(P>0.05).There was no significant correlation between the severity of FT in DLS group and LSS group with FJA,P-FA and Taillard index(P>0.05).The degree of facet joint degeneration was significantly different between DLS group and LSS group(P<0.05).In DLS-a group,the degree of degeneration of the joint process was signific

关 键 词：脊椎滑脱 椎管狭窄 椎间盘退行性变 腰椎 椎关节突关节 

分 类 号：R681.5[医药卫生—骨科学]