成人下颈椎关节突关节螺旋CT测量及临床意义
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摘要
目的：
①测量成人下颈椎关节突关节横断面长度、宽度及关节间隙大小等数据的正常值范围；②探讨其退变的评级方法,为临床观测提供量化的评级标准。
方法
①选用20例在读学生为正常组和40例颈椎病病人为病理组,分别行螺旋CT扫描并重建,测量下颈椎关节突关节横断面长度、宽度及关节间隙大小,计算出正常值范围；制定下颈椎关节突关节退变的评级标准。数据用SPSS 13.0统计软件包进行统计学分析,计算正常组、病理组各数据的均数及标准差；同一关节突关节左右数据间比较行配对T检验,正常组和病理组同一节段的各数据比较用独立样本T检验。②两名骨科医师、两名放射科医师依据上述标准评定40例颈椎病病人的160个下颈椎关节突关节的退变级别,一月后再次评级,不同观察者间的一致性、同一观察者两次评估的内部一致性,用加权kappa分析来检验。
结果
①正常组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm;关节突关节横断面宽度分别为：10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm；关节间隙中部(J2)最大,分别为：1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm;关节间隙两侧(J1、J3)略窄且基本对称。②病理组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm;关节突关节横断面宽度分别为：10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm;关节间隙中部(J2病)最大,分别为：1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm；关节间隙两侧(J1病、J3病)略窄且基本对称。③正常组和病理组间比较：C5/6关节面长度间差别有统计学意义；C4/5、C5/6关节面宽度间差别有统计学意义；C3/4、C4/5、C5/6、C6/7关节间隙大小间差别均有统计学意义；病理组关节突关节退变的特征表现为：关节突肥大、骨赘形成、关节面不规则、关节间隙狭窄、软骨下骨坏死、软骨下骨囊性变。④自行拟定的评级标准对40例颈椎病病人160个下颈椎关节突关节退变的评级结果,骨科医师与放射医师间的一致性KA1C1=0.659、KB1D1=0.705;高年资医师与低年资医师间的一致性KA1B1=0.688、KC1D1=0.677。四个评估者两次评估间的一致性KA-D=0.755-0.821。
结论
1.本研究的测量数据,为研究成人下颈椎关节突关节的影像解剖学提供了正常值参考。
2.自行设计了一种新的下颈椎关节突关节退变的评级标准,分为0-Ⅲ级,该评级标准经临床检测是一个可靠的影像学评估方法,适用于不同经验、不同学科的医生。
Object
①To measure the normal range of data of adult lower cervical facet joint cross-sectional length, width and joint space size.②To explore the method of the assessment of facet joint degeneration, providing quantitative ratings-criterion for the clinical observations.
Methods
①Twenty students as normal group and fourty cervical spondylosis patients as pathological groups, respectively, scanned by the way of helical computer tomography and reconstruction, measuring the data of lower cervical facet joint cross-sectional length, width and joint space size, calculating the normal range; formulating ratings-criterion of lower cervical facet joint degeneration. To analyze the data by SPSS13.0, calculating the mean and standard deviation of all measurement of the normal group and pathological group, comparing the measurement of the same facet joint between left and right using the paired T test, comparing the measurement of same segment between normal group and pathological group using the independent samples T test.②Two orthopedic doctors, two radiologists assess one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on this criteria, after one month, reassess all levels; To analyze inter-rater agreement between the ratings of all raters and the intra-rater agreement between the ratings of the same rater using weighted kappa.
Results
①The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the normal group, got the averaged measurements of both sides.Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm; facet joint cross-sectional width:10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm; central joint space size (J2) were the most:1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm; joint space on both sides (J1, J3) are slightly narrower and the basic symmetry.②The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the Pathology group, got the averaged measurements of both sides. Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm; facet joint cross-sectional width:10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm; central joint space size(J2病)were the most:1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm; joint space on both sides(J1病、J3病)are slightly narrower and the basic symmetry.③The comparisons of length of C5/6 between normal and pathological are statistically meaningful; the comparisons of width of C4/5、C5/6 between normal and pathological are statistically meaningful; the comparisons of joint space size of C3/4、C4/5、C5/6、C6/7 between normal and pathological are statistically meaningful. Degeneration of pathology group facet joints group of facet joint pathology is characterized by facet hypertrophy, osteophyte formation, articular surface irregularity, joint space narrowing, subchondral bone destruction and subchondral bone cystic.④The results of assessing one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on self-developed rating criteria, inter-rater agreement between orthopedic and radiologists surgeons KA1C1=0.659、KB1D1=0.705; inter-rater agreement between experienced and inexperienced raters KA1B1=0.688, KC1D1=0.677. inter-rater agreement between the ratings of all raters KA-D=0.755-0.821.
Conclusions
1. Measurements of this study provide the normal reference of studying imaging anatomy of adult lower cervical facet joints;
2. Self-designed rating criteria of degeneration of lower cervical facet joints is new, which can be divided into 0-Ⅲgrade, This ratings-criterion is a reliable imaging assessment method with clinical testing, which can be used by both experienced as well as inexperienced doctors from different disciplines.
①测量成人下颈椎关节突关节横断面长度、宽度及关节间隙大小等数据的正常值范围；②探讨其退变的评级方法,为临床观测提供量化的评级标准。
方法
①选用20例在读学生为正常组和40例颈椎病病人为病理组,分别行螺旋CT扫描并重建,测量下颈椎关节突关节横断面长度、宽度及关节间隙大小,计算出正常值范围；制定下颈椎关节突关节退变的评级标准。数据用SPSS 13.0统计软件包进行统计学分析,计算正常组、病理组各数据的均数及标准差；同一关节突关节左右数据间比较行配对T检验,正常组和病理组同一节段的各数据比较用独立样本T检验。②两名骨科医师、两名放射科医师依据上述标准评定40例颈椎病病人的160个下颈椎关节突关节的退变级别,一月后再次评级,不同观察者间的一致性、同一观察者两次评估的内部一致性,用加权kappa分析来检验。
结果
①正常组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm;关节突关节横断面宽度分别为：10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm；关节间隙中部(J2)最大,分别为：1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm;关节间隙两侧(J1、J3)略窄且基本对称。②病理组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm;关节突关节横断面宽度分别为：10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm;关节间隙中部(J2病)最大,分别为：1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm；关节间隙两侧(J1病、J3病)略窄且基本对称。③正常组和病理组间比较：C5/6关节面长度间差别有统计学意义；C4/5、C5/6关节面宽度间差别有统计学意义；C3/4、C4/5、C5/6、C6/7关节间隙大小间差别均有统计学意义；病理组关节突关节退变的特征表现为：关节突肥大、骨赘形成、关节面不规则、关节间隙狭窄、软骨下骨坏死、软骨下骨囊性变。④自行拟定的评级标准对40例颈椎病病人160个下颈椎关节突关节退变的评级结果,骨科医师与放射医师间的一致性KA1C1=0.659、KB1D1=0.705;高年资医师与低年资医师间的一致性KA1B1=0.688、KC1D1=0.677。四个评估者两次评估间的一致性KA-D=0.755-0.821。
结论
1.本研究的测量数据,为研究成人下颈椎关节突关节的影像解剖学提供了正常值参考。
2.自行设计了一种新的下颈椎关节突关节退变的评级标准,分为0-Ⅲ级,该评级标准经临床检测是一个可靠的影像学评估方法,适用于不同经验、不同学科的医生。
Object
①To measure the normal range of data of adult lower cervical facet joint cross-sectional length, width and joint space size.②To explore the method of the assessment of facet joint degeneration, providing quantitative ratings-criterion for the clinical observations.
Methods
①Twenty students as normal group and fourty cervical spondylosis patients as pathological groups, respectively, scanned by the way of helical computer tomography and reconstruction, measuring the data of lower cervical facet joint cross-sectional length, width and joint space size, calculating the normal range; formulating ratings-criterion of lower cervical facet joint degeneration. To analyze the data by SPSS13.0, calculating the mean and standard deviation of all measurement of the normal group and pathological group, comparing the measurement of the same facet joint between left and right using the paired T test, comparing the measurement of same segment between normal group and pathological group using the independent samples T test.②Two orthopedic doctors, two radiologists assess one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on this criteria, after one month, reassess all levels; To analyze inter-rater agreement between the ratings of all raters and the intra-rater agreement between the ratings of the same rater using weighted kappa.
Results
①The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the normal group, got the averaged measurements of both sides.Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm; facet joint cross-sectional width:10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm; central joint space size (J2) were the most:1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm; joint space on both sides (J1, J3) are slightly narrower and the basic symmetry.②The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the Pathology group, got the averaged measurements of both sides. Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm; facet joint cross-sectional width:10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm; central joint space size(J2病)were the most:1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm; joint space on both sides(J1病、J3病)are slightly narrower and the basic symmetry.③The comparisons of length of C5/6 between normal and pathological are statistically meaningful; the comparisons of width of C4/5、C5/6 between normal and pathological are statistically meaningful; the comparisons of joint space size of C3/4、C4/5、C5/6、C6/7 between normal and pathological are statistically meaningful. Degeneration of pathology group facet joints group of facet joint pathology is characterized by facet hypertrophy, osteophyte formation, articular surface irregularity, joint space narrowing, subchondral bone destruction and subchondral bone cystic.④The results of assessing one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on self-developed rating criteria, inter-rater agreement between orthopedic and radiologists surgeons KA1C1=0.659、KB1D1=0.705; inter-rater agreement between experienced and inexperienced raters KA1B1=0.688, KC1D1=0.677. inter-rater agreement between the ratings of all raters KA-D=0.755-0.821.
Conclusions
1. Measurements of this study provide the normal reference of studying imaging anatomy of adult lower cervical facet joints;
2. Self-designed rating criteria of degeneration of lower cervical facet joints is new, which can be divided into 0-Ⅲgrade, This ratings-criterion is a reliable imaging assessment method with clinical testing, which can be used by both experienced as well as inexperienced doctors from different disciplines.
引文
[1]Butler D, Trafimow J, Andersson G, et al. Discs degenerate before facets. Spine, 1990,15(2):111-113
[2]Bland JH, Boushey DR. Anatomy and physiology of the cervical spine. Semin Arthritis Rheum,1990,20(1):1-20
[3]Yoganandan N, Knowles SA,Maiman DJ, et al. Anatomic study of the morphology of human cervical facet joint. Spine,2003,28:2317-23
[4]贾连顺.颈椎关节突关节骨性关节炎.中国脊柱脊髓杂志,2009,19(1)：72-73
[5]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, andlumbar regions. J BMC Musculoskelet Disord,2004,5:15-23.
[6]Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 to 10 year radiologic and clinical follow-up study. J Spine,2005,30(19):2138-44
[7]Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. J Neurosurg,1995,63:278-282
[8]Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. Atlas of standard radiographs of arthritis. Blackwell Scientific Publications, Oxford, 1963:14-19
[9]Joris W, Baoge L, Jos VS, et al. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints.J Eur Spine, 2009,18(3):358-369
[10]. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. J Eur Spine,2006,15(6):705-718
[11]Cote P, Cassidy JD, Yong-Hing K, et al. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs. J Spine,1997,22(8):859-864
[12]杨秀军,陈峰,韩萍.仿真影像学[M].北京：人民卫生出版社,2002：12
[13]李雯,李大华,段磊.多层螺旋CT多平面重建在腰椎小关节损伤中的诊断价值.J医 用放射技术杂志,2006,252(8)：57
[14]Landis JR, Koch GG. The measurement of observer agreement forcategorical data. Biometrics,1977,33:159-174
[15]Clark CR.The Cervical Spine Research Society, Editorial Committee. The cervical spine.4th ed. Philadelphia:Lippincott Williams & Wilkins,2005:1057-71
[16]Uhrenholt L, Hauge E, Charles, et al. Degenerative arid traumatic changes in the lower cervical spine facet joints. Scand J Rheumatol,2008,37(5):375-84
[17]Inami S, Kaneoka K, Hayashi K, et al. Types of synovial fold in the cervical facet joint. J Orthop Sci,2000,5(5):475-480
[18]Johnson GM. The sensory and sympathetic nerve supply with in the cervical spine: review of recent observations. J Man Ther,2004,9(2):71-76
[19]Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine,1982, 7(4):319-30
[20]Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982,165:110-23
[21]Barnsley L, Lord S, Wall is B, et al. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain,1993,9:124-30
[22]Speldewinde GC, Bashford GM, Davidson IR. Diagnostic cervical zygapophyseal joint blocks for chronic cervical pain. Med J Aust,2001,174:174-6
[23]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord,2004,5:15
[24]A Kettler, K Werner, H-J Wilke. Morphological changes of cervical facet joints in elderly individuals. J Eur Spine 2007,16:987-992
[25]Haughton V. Imaging techniques in intraspinal diseases. In:Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia:Saunders,1995,237-76
[26]Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology,1987,164:227-230
[27]常剑虹,赵卫东,宋大庆等.椎小关节病的CT诊断.中华放射学杂志,1994,28(3)：175-178
[28]Carrera GF, Haughton VM, Syvertsen A, et al. Computed tomography of the facet joints. Radiology,1980,134:145-8
[29]Grenier N, Kressel HY, Schiebler ML, et al. Normal and degenerative posterior spinal structures:MR imaging. Radiology,1987,165:517-25.
[30]Dominik W, Marco Z, Norbert B, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol,1999,28:215-219
[31]Nelemans PJ, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic benign low back pain. Spine,2001,26:501-15
[32]Leone A, Aulisa L, Tamburrelli F, et al. Ruolo della tomografia computerizzata e della risonanza magnetica nella valutazione della artropatia degenerativa delle facette articolari lombari. Radiol Med,1994,88:547-52
[33]Panjabi MM, Oxland T, Takata K, et al. Articular facets of the human spine. Quantitative three-dimensional anatomy. Spine,1993,18(10):1298-310
[34]孟庆兰.颈椎间关节面的形态和面积与颈椎病的关系.中国康复理论与实践,2002,8(2)：134-135
[35]Lee RY, McGregor AH, Bull AM, et al. Dynamic response of the cervical spine to posteroanterior mobilisation. Clin Biomech,2005,20 (2):228-231
[36]Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomech,2005,38 (6):1313-1323
[37]朱丹.多层螺旋CT曲面重组成像技术显示下腰椎小关节病的研究.放射学实践,,2005,20(3)：248-250
[38]Miyazaki M, Hong SW, Yoon SH, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Journal of spinal disorders & techniques,2009,18:358-369
[39]Kettler A, Rohlmann F, etal. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration:Part II. Cervical spine. Eur Spine J. Epub,2006,15(6):732-41
[40]Fletcher G, Haughton VM, etal. Age-related changes in the cervical facet joints: studies with cryomicrometry, MR, and CT. AJR Am J Roentgenol,1990,154:817-20
[1]Goffin J, Casey A, Kehr P, Liebig K, et al.Preliminary clinical experienc∈ with the Bryan cervical disc prosthesis.Neurosurgery,2002,51(3):840-7
[2]Tanaka M. A patho logic study of discs in the elderly. J Spine,1993,18 (11) 1456-62
[3]Dwyer A, Ap rill C, Bogduk NA. Cervical zygapophyseal joint pain patterns. I: a study in normal volunteers. J Spine,1990,15(6):453-7
[4]Suzuk iM, Shimamura T. Morphological study of the axial view of the cervical spinal cord by MR images. Nippon Seikeigeka Gakkai Zassh i,1994,68 (1):1-13
[5]Hayashi H, Okada K, Hamada M, etal. Etiologic factors of myelopathy. Clin Orthop,1987,214:200-209
[6]吕宏,李家顺,贾连顺等.颈椎椎间盘与椎体高度比值的测量及其临床意义.第二军医大学学报,2000,9(21)：873-893
[7]薛厌云,黄公怡.颈椎退变的线分析.中华骨科杂志,1994,14(9)：530-533
[8]Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. Atlas of standard radiographs of arthritis. Blackwell Scientific Publications, Oxford, 1963:14-19
[9]Cote P, Cassidy JD, Yong-Hing K, et al. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs. J Spine,1997,22(8):859-864
[10]Christe A, Laubli R, Guzman R, etal. Degeneration of the cervical disc:histology compared with radiography and magnetic resonance imaging. J Neuroradiology, 2005,47(10):721-729
[11]Kettler A, Rohlmann F, etal. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration:Part Ⅱ. Cervical spine. J Eur Spine Epub,2006,15(6):732-41
[12]Frobin W, Leivseth G, etal. Vertebral height, disc height, posterior displacement and dens-atlas gap in the cervical spine:precision measurement protocol and normal data. Clin Biomech,2002,17:423-31
[13]Joris Walraevens, Baoge Liu, etal. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs arid facet joints. J Eur Spine, 2009,18:358-369
[14]Russell EJ.Cervical disk disease, Radiology,1990,177:313-325
[15]Enzmann DR, Rubin JR. Cervical spine:MR imaging with a partial flip angle, gradient-refocused pulse sequence. Part I. General considerations and disc disease. Radiology,1988,166:467-472
[16]Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. J Bone J Surg,1990,72:1178-84
[17]Lehto IJ, Tertti MO, Komu ME, et al. Age-related MRI changes at 0.1 T in cervical discs in asymptomaticsubjects. Neuroradiology,1994,36(1):49-53
[18]Tertti M, Paajanen H, Laato M, et al. Disc degeneration in magnetic resonance imaging. A comparative biochemical, histologic, and radiologic study in cadaver spines. Spine,1991,16(6):629-634
[19]Berlemann U, Gries NC, Moore RJ. The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs. J Eur Spine, 1998,7:212-217
[20]Yu SW, Sether LA, et al. Tears of the anulus fibrosus:correlation between MR and pathologic findings in cadavers. AJNR Am JNeuroradiol,1988,9:3677-370
[21]Kolstad F, Myhr G, Kvistad KA, et al. Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol,2005,55:415-420
[22]Frobin W, Leivseth G, et al. Sagittal plane motion of the cervical spine A new precision measurement protocol and normal motion data of healthy adults. Clin Biomech,2002,17:21-31
[23]Miyazaki M, Hong SW, Yoon SH, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. Journal of spinal disorders & techniques,2009,18:358-369
[24]Butt WP:Discography:Technique and interpretation of results. J Bone Joint Surg,1969,51B:225-237
[25]Cloward RB:Cervical discography. Technique, indications and use indiagnosis of ruptured cerical disks. AJR,1958,79:563-574
[26]Klafta LA, Collis, JS. An Analysis of Cervical Discography with Surgical Verification. J Neurosurg,1969,30:38-41
[27]Parfenchuck TA, Janssen ME. A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms.1994,19(24):2819-25
[28]Schellhas KP, Pollei SR, Dorwart RH. Thoracic discography:A safe and reliable technique. Spine,1994,19(18):2103-9
[29]Klafta LA Jr, Collis JS. The diagnostic inaccuracy of the pain response in cervical'discography. Cleve Clin Q,1969,36(1):35-39
[30]WILLIAMS JL, MARSHALL BA, et al.Late Results of Cervical Discectomy and. Interbody Fusion:Some Factors Influencing the Results.J Bone and Joint Surg, 1968,50:277-286
[31]Viikari-Juntura E, Raininko R, Videman T, et al. Evaluation of cervical disc degeneration with ultralow field MRI and discography. An experimental study on cadavers. Spine,1989,14(6):616-61
[32]VIDEMAN T, MALMIVAARA A, MOONEY V. The Value of the Axial View in Assessing Discograms:An Experimental Study with Cadavers. J Spine,1987,12:299-304
[33]Schellhas KP, Smith MD, Gundry CR, et al. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine,1996,21(3):300-11
[34]贾连顺.颈椎关节突关节骨性关节炎.中国脊柱脊髓杂志,2009,19(1)：72-73
[35]Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 to 10 year radiologic and clinical follow-up study. J Spine,2005,30(19):2138-44
[36]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, andlumbar regions. J BMC Musculoskelet Disord,2004,5:15-23
[37]Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J,2006,15(6):705-718
[2]Bland JH, Boushey DR. Anatomy and physiology of the cervical spine. Semin Arthritis Rheum,1990,20(1):1-20
[3]Yoganandan N, Knowles SA,Maiman DJ, et al. Anatomic study of the morphology of human cervical facet joint. Spine,2003,28:2317-23
[4]贾连顺.颈椎关节突关节骨性关节炎.中国脊柱脊髓杂志,2009,19(1)：72-73
[5]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, andlumbar regions. J BMC Musculoskelet Disord,2004,5:15-23.
[6]Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 to 10 year radiologic and clinical follow-up study. J Spine,2005,30(19):2138-44
[7]Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. J Neurosurg,1995,63:278-282
[8]Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. Atlas of standard radiographs of arthritis. Blackwell Scientific Publications, Oxford, 1963:14-19
[9]Joris W, Baoge L, Jos VS, et al. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints.J Eur Spine, 2009,18(3):358-369
[10]. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. J Eur Spine,2006,15(6):705-718
[11]Cote P, Cassidy JD, Yong-Hing K, et al. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs. J Spine,1997,22(8):859-864
[12]杨秀军,陈峰,韩萍.仿真影像学[M].北京：人民卫生出版社,2002：12
[13]李雯,李大华,段磊.多层螺旋CT多平面重建在腰椎小关节损伤中的诊断价值.J医 用放射技术杂志,2006,252(8)：57
[14]Landis JR, Koch GG. The measurement of observer agreement forcategorical data. Biometrics,1977,33:159-174
[15]Clark CR.The Cervical Spine Research Society, Editorial Committee. The cervical spine.4th ed. Philadelphia:Lippincott Williams & Wilkins,2005:1057-71
[16]Uhrenholt L, Hauge E, Charles, et al. Degenerative arid traumatic changes in the lower cervical spine facet joints. Scand J Rheumatol,2008,37(5):375-84
[17]Inami S, Kaneoka K, Hayashi K, et al. Types of synovial fold in the cervical facet joint. J Orthop Sci,2000,5(5):475-480
[18]Johnson GM. The sensory and sympathetic nerve supply with in the cervical spine: review of recent observations. J Man Ther,2004,9(2):71-76
[19]Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine,1982, 7(4):319-30
[20]Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982,165:110-23
[21]Barnsley L, Lord S, Wall is B, et al. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain,1993,9:124-30
[22]Speldewinde GC, Bashford GM, Davidson IR. Diagnostic cervical zygapophyseal joint blocks for chronic cervical pain. Med J Aust,2001,174:174-6
[23]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord,2004,5:15
[24]A Kettler, K Werner, H-J Wilke. Morphological changes of cervical facet joints in elderly individuals. J Eur Spine 2007,16:987-992
[25]Haughton V. Imaging techniques in intraspinal diseases. In:Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia:Saunders,1995,237-76
[26]Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology,1987,164:227-230
[27]常剑虹,赵卫东,宋大庆等.椎小关节病的CT诊断.中华放射学杂志,1994,28(3)：175-178
[28]Carrera GF, Haughton VM, Syvertsen A, et al. Computed tomography of the facet joints. Radiology,1980,134:145-8
[29]Grenier N, Kressel HY, Schiebler ML, et al. Normal and degenerative posterior spinal structures:MR imaging. Radiology,1987,165:517-25.
[30]Dominik W, Marco Z, Norbert B, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol,1999,28:215-219
[31]Nelemans PJ, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic benign low back pain. Spine,2001,26:501-15
[32]Leone A, Aulisa L, Tamburrelli F, et al. Ruolo della tomografia computerizzata e della risonanza magnetica nella valutazione della artropatia degenerativa delle facette articolari lombari. Radiol Med,1994,88:547-52
[33]Panjabi MM, Oxland T, Takata K, et al. Articular facets of the human spine. Quantitative three-dimensional anatomy. Spine,1993,18(10):1298-310
[34]孟庆兰.颈椎间关节面的形态和面积与颈椎病的关系.中国康复理论与实践,2002,8(2)：134-135
[35]Lee RY, McGregor AH, Bull AM, et al. Dynamic response of the cervical spine to posteroanterior mobilisation. Clin Biomech,2005,20 (2):228-231
[36]Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomech,2005,38 (6):1313-1323
[37]朱丹.多层螺旋CT曲面重组成像技术显示下腰椎小关节病的研究.放射学实践,,2005,20(3)：248-250
[38]Miyazaki M, Hong SW, Yoon SH, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Journal of spinal disorders & techniques,2009,18:358-369
[39]Kettler A, Rohlmann F, etal. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration:Part II. Cervical spine. Eur Spine J. Epub,2006,15(6):732-41
[40]Fletcher G, Haughton VM, etal. Age-related changes in the cervical facet joints: studies with cryomicrometry, MR, and CT. AJR Am J Roentgenol,1990,154:817-20
[1]Goffin J, Casey A, Kehr P, Liebig K, et al.Preliminary clinical experienc∈ with the Bryan cervical disc prosthesis.Neurosurgery,2002,51(3):840-7
[2]Tanaka M. A patho logic study of discs in the elderly. J Spine,1993,18 (11) 1456-62
[3]Dwyer A, Ap rill C, Bogduk NA. Cervical zygapophyseal joint pain patterns. I: a study in normal volunteers. J Spine,1990,15(6):453-7
[4]Suzuk iM, Shimamura T. Morphological study of the axial view of the cervical spinal cord by MR images. Nippon Seikeigeka Gakkai Zassh i,1994,68 (1):1-13
[5]Hayashi H, Okada K, Hamada M, etal. Etiologic factors of myelopathy. Clin Orthop,1987,214:200-209
[6]吕宏,李家顺,贾连顺等.颈椎椎间盘与椎体高度比值的测量及其临床意义.第二军医大学学报,2000,9(21)：873-893
[7]薛厌云,黄公怡.颈椎退变的线分析.中华骨科杂志,1994,14(9)：530-533
[8]Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. Atlas of standard radiographs of arthritis. Blackwell Scientific Publications, Oxford, 1963:14-19
[9]Cote P, Cassidy JD, Yong-Hing K, et al. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs. J Spine,1997,22(8):859-864
[10]Christe A, Laubli R, Guzman R, etal. Degeneration of the cervical disc:histology compared with radiography and magnetic resonance imaging. J Neuroradiology, 2005,47(10):721-729
[11]Kettler A, Rohlmann F, etal. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration:Part Ⅱ. Cervical spine. J Eur Spine Epub,2006,15(6):732-41
[12]Frobin W, Leivseth G, etal. Vertebral height, disc height, posterior displacement and dens-atlas gap in the cervical spine:precision measurement protocol and normal data. Clin Biomech,2002,17:423-31
[13]Joris Walraevens, Baoge Liu, etal. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs arid facet joints. J Eur Spine, 2009,18:358-369
[14]Russell EJ.Cervical disk disease, Radiology,1990,177:313-325
[15]Enzmann DR, Rubin JR. Cervical spine:MR imaging with a partial flip angle, gradient-refocused pulse sequence. Part I. General considerations and disc disease. Radiology,1988,166:467-472
[16]Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. J Bone J Surg,1990,72:1178-84
[17]Lehto IJ, Tertti MO, Komu ME, et al. Age-related MRI changes at 0.1 T in cervical discs in asymptomaticsubjects. Neuroradiology,1994,36(1):49-53
[18]Tertti M, Paajanen H, Laato M, et al. Disc degeneration in magnetic resonance imaging. A comparative biochemical, histologic, and radiologic study in cadaver spines. Spine,1991,16(6):629-634
[19]Berlemann U, Gries NC, Moore RJ. The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs. J Eur Spine, 1998,7:212-217
[20]Yu SW, Sether LA, et al. Tears of the anulus fibrosus:correlation between MR and pathologic findings in cadavers. AJNR Am JNeuroradiol,1988,9:3677-370
[21]Kolstad F, Myhr G, Kvistad KA, et al. Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol,2005,55:415-420
[22]Frobin W, Leivseth G, et al. Sagittal plane motion of the cervical spine A new precision measurement protocol and normal motion data of healthy adults. Clin Biomech,2002,17:21-31
[23]Miyazaki M, Hong SW, Yoon SH, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. Journal of spinal disorders & techniques,2009,18:358-369
[24]Butt WP:Discography:Technique and interpretation of results. J Bone Joint Surg,1969,51B:225-237
[25]Cloward RB:Cervical discography. Technique, indications and use indiagnosis of ruptured cerical disks. AJR,1958,79:563-574
[26]Klafta LA, Collis, JS. An Analysis of Cervical Discography with Surgical Verification. J Neurosurg,1969,30:38-41
[27]Parfenchuck TA, Janssen ME. A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms.1994,19(24):2819-25
[28]Schellhas KP, Pollei SR, Dorwart RH. Thoracic discography:A safe and reliable technique. Spine,1994,19(18):2103-9
[29]Klafta LA Jr, Collis JS. The diagnostic inaccuracy of the pain response in cervical'discography. Cleve Clin Q,1969,36(1):35-39
[30]WILLIAMS JL, MARSHALL BA, et al.Late Results of Cervical Discectomy and. Interbody Fusion:Some Factors Influencing the Results.J Bone and Joint Surg, 1968,50:277-286
[31]Viikari-Juntura E, Raininko R, Videman T, et al. Evaluation of cervical disc degeneration with ultralow field MRI and discography. An experimental study on cadavers. Spine,1989,14(6):616-61
[32]VIDEMAN T, MALMIVAARA A, MOONEY V. The Value of the Axial View in Assessing Discograms:An Experimental Study with Cadavers. J Spine,1987,12:299-304
[33]Schellhas KP, Smith MD, Gundry CR, et al. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine,1996,21(3):300-11
[34]贾连顺.颈椎关节突关节骨性关节炎.中国脊柱脊髓杂志,2009,19(1)：72-73
[35]Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5 to 10 year radiologic and clinical follow-up study. J Spine,2005,30(19):2138-44
[36]Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, andlumbar regions. J BMC Musculoskelet Disord,2004,5:15-23
[37]Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J,2006,15(6):705-718