退变性腰椎侧凸关节突关节与椎间孔的变化及其意义
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摘要
目的:通过对退变性腰椎侧凸Cobb角、关节突关节角与椎间孔纵横径的影像学测量,分析退变性腰椎侧凸关节突关节与椎间孔的变化及腰腿痛特点,并对其发病机制作进一步探讨。
方法:退变性腰椎侧凸69例,其中男30例,女39例;年龄50～78岁,平均63.5岁,为LDS组。同期收治的非脊柱疾患的患者68例,男32例,女36例;年龄50～76岁,平均59.6岁,为对照组。X-ray片上测量腰椎Cobb角,腰椎MSCT薄层扫描,在PACS系统上逐层阅片,测量软件测量所有受试者L1-L5关节突关节角与RAsag角。将腰椎MSCT扫描数据导入医学重建软件,进行椎间孔3D重建,利用软件测量L1-L5腰椎间孔纵径及横径的大小。将LDS组与对照组的关节突关节角、椎间孔指标采用两样本均数T检验,对LDS组各项测量指标进行多元相关性分析。
结果:LDS组Cobb角10～39.8°,平均18.21°±8.89°,腰椎关节突关节均有不同程度的退变,所有节段的凹侧关节突关节角角度均大于凸侧;对照组所有节段两侧关节突关节角角度没有显著性差异(P>O.05)。腰椎间孔侧量值中,LDS组的椎间孔横径和纵径与对照组相比均变窄,两组比较有显著差(P<0.05),凹侧腰椎间孔横径较凸侧变小(P<0.05),而凹侧腰椎间孔纵径与凸侧相比无明显差异(P>0.05),对照组的腰椎间孔横径及纵径左右两侧对比无显著性差异。
结论:1.退变性腰椎侧凸两侧关节突关节不对称,凹侧关节突关节角大于凸侧。
2.退变性腰椎侧凸两侧腰椎间孔纵横径均存在变窄,凹侧腰椎间孔横径变窄比凸侧显著。
3.退变性腰椎侧凸侧弯侧关节突关节角变大是导致该侧腰椎间孔横径狭窄的主要原因
4.腰椎关节突关节两侧不对称可能是退变性腰椎侧凸的重要发病机制之一。
Objective: To measure the lumbar Cobb angle, facet joints angle and foraminal size by images of lumber degenerative scoliosis, and to explore its morphological Characteristics and pathogenesis.
Methods: 69 cases with lumber degenerative scoliosis(30 males and 39 females, aged 50 to 78 years, average 63.5 years old )and 68 normal controls( 32 male and 36 female, aged 50 to 76 years, average 59.6 years old) with did not have spinal deformity in this study. Measuring the lumbar Cobb angle in X-ray image.Successive CT lumbar vertebras scanning of all subjects were obtained,the orientation of lumbar facet joints and lumbar vertebras foraminal of all participants were measured with the software of PACS Client. In the control group, bilateral facet joints and intervertebral foramen were compared using paired-t test. In LDS group,the concave and convex side size of facet joints and intervertebral foramen were analyzed using paired-t test . linear correlations between the image index of the scoliosis group and clinical parameters,were calculated using Pearson correlation coefficients.
RESULTS: The cobb angle of lumber degenerative scoliosis was 10 ~ 39.8°, an average of 18.21°±8.89°, In control group,no difference were found in bilateral orientation of lumbar facet joints(P >0.05).In LDS group,the orientation of lumbar facet joints in the concave side Was lager than that in the convex side(P<0.05).The lumbar foraminal longitudinal diameter and sagittal diameter of LDS group were lower than control group(P<0.05). In LDS group,the lumbar intervertebral foramen sagittal diameter of concave side is smaller than that in the convex side , there were significant differences between the two groups (P <0.05),while there were no significant differences between the concave side of foraminal longitudinal diameter and the convex side. In control group,no difference were found in bilateral lumbar intervertebral foramen(P >0.05) .
Conclusion: 1. Our findings suggested that the lumbar facet joints on both sides of lumber degenerative scoliosis are asymmetry ,and the facet joint angle in the concave side is largeer than that in the convex side.
2. The lumbar intervertebral foramina longitudinal diameter and sagittal diameter of lumber degenerative scoliosis are all narrow,and the lumbar intervertebral foramina sagittal diameter in the concave side was significantly narrower than that in the convex side.
3.The main reasons that the lumbar intervertebral foramina sagittal diameter became narrow in the concave side of lumber degenerative scoliosis was the lumbar facet joints angel in the concave side increase leading to degenerative proliferation of facet joint
4. Our study suggests that the lumbar facet joints with asymmetry on both sides is an important pathogenesis for lumber degenerative scoliosis.
方法:退变性腰椎侧凸69例,其中男30例,女39例;年龄50～78岁,平均63.5岁,为LDS组。同期收治的非脊柱疾患的患者68例,男32例,女36例;年龄50～76岁,平均59.6岁,为对照组。X-ray片上测量腰椎Cobb角,腰椎MSCT薄层扫描,在PACS系统上逐层阅片,测量软件测量所有受试者L1-L5关节突关节角与RAsag角。将腰椎MSCT扫描数据导入医学重建软件,进行椎间孔3D重建,利用软件测量L1-L5腰椎间孔纵径及横径的大小。将LDS组与对照组的关节突关节角、椎间孔指标采用两样本均数T检验,对LDS组各项测量指标进行多元相关性分析。
结果:LDS组Cobb角10～39.8°,平均18.21°±8.89°,腰椎关节突关节均有不同程度的退变,所有节段的凹侧关节突关节角角度均大于凸侧;对照组所有节段两侧关节突关节角角度没有显著性差异(P>O.05)。腰椎间孔侧量值中,LDS组的椎间孔横径和纵径与对照组相比均变窄,两组比较有显著差(P<0.05),凹侧腰椎间孔横径较凸侧变小(P<0.05),而凹侧腰椎间孔纵径与凸侧相比无明显差异(P>0.05),对照组的腰椎间孔横径及纵径左右两侧对比无显著性差异。
结论:1.退变性腰椎侧凸两侧关节突关节不对称,凹侧关节突关节角大于凸侧。
2.退变性腰椎侧凸两侧腰椎间孔纵横径均存在变窄,凹侧腰椎间孔横径变窄比凸侧显著。
3.退变性腰椎侧凸侧弯侧关节突关节角变大是导致该侧腰椎间孔横径狭窄的主要原因
4.腰椎关节突关节两侧不对称可能是退变性腰椎侧凸的重要发病机制之一。
Objective: To measure the lumbar Cobb angle, facet joints angle and foraminal size by images of lumber degenerative scoliosis, and to explore its morphological Characteristics and pathogenesis.
Methods: 69 cases with lumber degenerative scoliosis(30 males and 39 females, aged 50 to 78 years, average 63.5 years old )and 68 normal controls( 32 male and 36 female, aged 50 to 76 years, average 59.6 years old) with did not have spinal deformity in this study. Measuring the lumbar Cobb angle in X-ray image.Successive CT lumbar vertebras scanning of all subjects were obtained,the orientation of lumbar facet joints and lumbar vertebras foraminal of all participants were measured with the software of PACS Client. In the control group, bilateral facet joints and intervertebral foramen were compared using paired-t test. In LDS group,the concave and convex side size of facet joints and intervertebral foramen were analyzed using paired-t test . linear correlations between the image index of the scoliosis group and clinical parameters,were calculated using Pearson correlation coefficients.
RESULTS: The cobb angle of lumber degenerative scoliosis was 10 ~ 39.8°, an average of 18.21°±8.89°, In control group,no difference were found in bilateral orientation of lumbar facet joints(P >0.05).In LDS group,the orientation of lumbar facet joints in the concave side Was lager than that in the convex side(P<0.05).The lumbar foraminal longitudinal diameter and sagittal diameter of LDS group were lower than control group(P<0.05). In LDS group,the lumbar intervertebral foramen sagittal diameter of concave side is smaller than that in the convex side , there were significant differences between the two groups (P <0.05),while there were no significant differences between the concave side of foraminal longitudinal diameter and the convex side. In control group,no difference were found in bilateral lumbar intervertebral foramen(P >0.05) .
Conclusion: 1. Our findings suggested that the lumbar facet joints on both sides of lumber degenerative scoliosis are asymmetry ,and the facet joint angle in the concave side is largeer than that in the convex side.
2. The lumbar intervertebral foramina longitudinal diameter and sagittal diameter of lumber degenerative scoliosis are all narrow,and the lumbar intervertebral foramina sagittal diameter in the concave side was significantly narrower than that in the convex side.
3.The main reasons that the lumbar intervertebral foramina sagittal diameter became narrow in the concave side of lumber degenerative scoliosis was the lumbar facet joints angel in the concave side increase leading to degenerative proliferation of facet joint
4. Our study suggests that the lumbar facet joints with asymmetry on both sides is an important pathogenesis for lumber degenerative scoliosis.
引文
[1] Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis[J].Am J Orthop,2003,32(2):77-82.
[2] Kluba T, Dikmenli G, Dietz K et al. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis[J].Arch Orthop Trauma Surg,2009,129(1):1-5.
[3] Ploumis A, Transfledt EE, Denis F et al. Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J,2007,7(4):428-436.
[4] Wu CH, Wong CB, Chen LH. Instrumented posterior lumbar interbedy fusionfor patients with degenerative lumbar scoliosis[J].Spinal Disent Tech,2008,21:310-315.
[5] Perennou D, Marcelli C, Hersson C, et a1. Adult lumbar soohosis,Epidemi-ologie aspects in a low-back pain populatio[J].Spine,1994,19(2):123-128.
[6] Fujiwara A, Tamai K, An HS. Orientation and osteoarthritis of the lumbar facet joint[J]. Clinical Orthopaedics and Related Research,2001,385:88-94.
[7]陈其昕,陈维善,徐少文.下腰椎疾患的腰椎小关节角变化规律及其临床意义.[J].中华骨科杂志,2000,20(1):55-57.
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[1] Kluba T, Dikmenli G, Dietz K et al.Comparison of surgical and conservati-ve treatment for degenerative lumbar scoliosis[J].Arch Orthop Trauma Surg, 2009,129(1):1-5.
[2] Ploumis A, Transfledt EE, Denis F, et al.Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J,2007,7(4):428-436.
[3] Daffner SD.Vaccaro AR Adult degenerative lumbar scoliosis [J].Am J Orthop,2003,32(2):77-82.
[4] Wu CH, Wong CB, Chen LH. Instrumented posterior lumbar interbedy fusion for patients with degenerative lumbar scoliosis [J]. Spinal Disent Tech,2008,21:310-315.
[5] Tribus CB, Degenerative. lumbar scoliosis:evaluation and management[J].J Am Acad Orthop Surg,2003,3:174-183.
[6] Kobayashi T, Atsuta Y, Takemitsu M . A prospective study of de novo scoliosis in a community based cohort [J].Spine,2006,31(2):178-182.
[7] Faldini C, Pagkrati S, Grandi G. Degenerative lumbar scoliosis:features and surgical treatment [J].J 0rthop Traumatol,2006,7(2):67-71.
[8] Panagiotis ZE, Athanasios K, Panagiotis D, et al. Functional outcome of surgical treatment for multilevel lumbar spinal stenosis[J].Acta Orthop,2006,77:670-676.
[9] DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65:surgical considerations and treatment options in patients with poor bone quality [J].Spine,2006,3l(suppl 19):144-151.
[10] Buttermann GR, Mullin WJ. Pain and disability correlated with disc degeneration via magnetic resonance imaging in scoliosis patients. [J].Eur Spine J,2008,17(2):240-249.
[11] Kim HJ, Chun HJ, Kang KT, et al. A validated finite element analysis ofnerve root stress in degenerative lumbar scoliosis[J].Med Biol Eng Comput,2009,47(6):599-605
[12] Perennou D,Marcelli C,Hersson C,et a1. Adult lumbar soohosis,Epidemiologie aspects in a low-back pain populatio[J].Spine,1994,19(2):123-128.
[13] Liu H, Ishihara H, Kanamori M, et al. Characteristics ofnerve root compression caused by degenerative lumbar spinal stenosis with scoliosis[J].Spine J, 2003, 3:524-529.
[14] Deviren V,Berven S,Kleinstueck F,Antinnes J. Smith JA. Hu SS.Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic seoliosis[J],Spine,2002,27(2t):2346-2349.
[15] Ploumis A, Transfeldt EE, Gilbert TJ Jr, Mehbod AA, Dykes DC, Perra JE.Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions[J]. Spine,2006,31(20):2353-2358.
[16] Schwab F,Lafage V,Farcy JP,et a1.Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification[J]. Spine,2007,32:2723-2730.
[17] Schwab FJ,Smith VA,Bisemi M,et a1.Adult scoliosis:a quantitative radiographic and clinical analysis[J]. Spine,2002,27(4):387-392.
[18] Glassman SD.Bridwell KH.Dimar JR The impact of positive sagittal balance in adult spinal deformity [J]. Spine,2005,30(18):2024-2029.
[19] Pritchett JW,Boael DT.Degenerative symptomatic lumbar scoliosis[J]. Spine,1993,18:700-703.
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[21] Grobler LJ, Robertson PA , Novotny JE,el a1.Etiology 0f spondylolisthesis:assessment of the role played by lumbar facet joint morphology [J]. Spine,1993, 18(1):80-91.
[22] Fujiwara A,Tamai K,An HS,et a1.Orientation and osteoarthritis of the lumbar facet joint[J].Chn Orthop Relat Res.2001,385:88-94.
[23] Toyone T,Tanaka T,Kato D,et a1.Anatomic changes in lateral spondylolisthesis associated witll adult lumbar scohosis[J].Spine,2005,30(22):E67l-575.
[24] Pappou IP,Girardi FP, Sandhu HS, Parvahanenl HK,Cammisa FPJr,Schneider R.Frellnghuysen P,Lane JM.Discordantly high spinal bone mineral densityvalues in patients with adult lumbar scoliosis.[J].Spine.2006.31(14):1614-1620.
[25] Anand N, Baron EM, Thaiyananthan G, et al.Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study[J].J Spinal Disord Tech,2008,21(7):459-467.
[26] Jagannathan J, Sansur CA, Oskouian RJ Jr.et.al.Radiographic restoration oflumbar alignment after transforaminal lumbar interbody fusion[J].Neurosurg-ery,2009,64(5):955-963.
[2] Kluba T, Dikmenli G, Dietz K et al. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis[J].Arch Orthop Trauma Surg,2009,129(1):1-5.
[3] Ploumis A, Transfledt EE, Denis F et al. Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J,2007,7(4):428-436.
[4] Wu CH, Wong CB, Chen LH. Instrumented posterior lumbar interbedy fusionfor patients with degenerative lumbar scoliosis[J].Spinal Disent Tech,2008,21:310-315.
[5] Perennou D, Marcelli C, Hersson C, et a1. Adult lumbar soohosis,Epidemi-ologie aspects in a low-back pain populatio[J].Spine,1994,19(2):123-128.
[6] Fujiwara A, Tamai K, An HS. Orientation and osteoarthritis of the lumbar facet joint[J]. Clinical Orthopaedics and Related Research,2001,385:88-94.
[7]陈其昕,陈维善,徐少文.下腰椎疾患的腰椎小关节角变化规律及其临床意义.[J].中华骨科杂志,2000,20(1):55-57.
[8] Kunogi J, Hasue M. Diagnosis, operative treatment of intraforaminal andextraforamiual nerve root compression[J].Spine,1991,16:1312-1320.
[9] Grobler LJ, Robertson PA, Novotny JE. Etiology of spondylolisthesis:assessment of the role played by lumbar facet joint morphology[J].Spine,1993,18 (1):80-91.
[10] Boden SD, Riew KD, Yamaguchi K, et al. Orientation of the lumbar facetjoints:association with degenerative disc disease[J].Bone Joint Surg (Am),1996,78:403-411.
[11] Aaro S, Dahalborn M. Estimation of vertebral rotation and the spinal andrib cage deformity in scoliosis by computer tomography[J].Spine,1981,6(5):460-467.
[12] Hasegawa T, An S, Hanghton VM, et al. Lumbar foraminal stenosis:criticalheights of the intervertebral discs and foramina[J].Bone Joint Surg(Am),1995,77:32-38.
[13]陈家强,余明华,周立兵,等.胸腰段椎间孔的解剖学观测及其临床意义[J],郧阳医学院学报,2004,23(1):20-22.
[14] Tribus CB, Degenerative lumbar scoliosis:evaluation and management[J].Am Acad Orthop Surg,2003,3:174-183.
[15] Schwab F, Lafage V, Farcy JP, et a1. Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification[J].Spine,2007,32:2723-2730.
[16] Buttermann GR, Mullin WJ. Pain and disability correlated with disc dege-neration via magnetic resonance imaging in scoliosis patients[J].Eur Spine J, 2008,17(2):240-249.
[17] Schwab FJ, Smith VA, Bisemi M, et a1. Adult scoliosis:a quantitative radiographic and clinical analysis[J].Spine,2002,27(4):387-392.
[18] Glassman SD, Bridwell KH, Dimar JR. The impact of positive sagittal balance in adult spinal deformity [J].Spine,2005,30(18):2024-2029.
[19] Berven S, Tay BB, Colman W, et a1. The lumbar zygapophyseal (facet)joints:a role in the pathogenesis of spinal pain syndromes and degenerativespondylolisthesis[J].Semin Neurol,2002,22(2):187-196.
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