低位腰椎间盘突出症患者腰椎骨性结构的变化及其临床意义
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摘要
目的：
通过对下腰椎间盘突出症(Low Lumber Disc Herination, LLDH)患者腰椎骨性结构参数的测量和比较,分析这些参数的变化和LLDH的相关关系。探讨腰椎骨性结构的异常是否为腰椎间盘突出症的病因,以及在腰椎间盘退行性变中的意义。
方法：
1资料的收集：
2008-2010年收住莆田学院附属医院骨科的腰椎间盘突出症患者485例,随机抽取符合纳入标准的207例作为实验组；2008-2010年因慢性腰腿痛就诊我院骨科门诊患者700例,随机抽取符合纳入标准及CT检查显示无腰椎间盘突出者143例作为对照组。
2腰椎间盘突出症的诊断标准(依据胡有谷提出的诊断标准)：
2.1腿痛重于腰痛,腿痛呈典型的坐骨神经分布区域的疼痛。
2.2按神经分布区域的皮肤感觉麻木。
2.3直腿抬高较正常减少50%,兼或有好腿抬高试验阳性,作弓弦试验即胭窝区域指压胫神经引起肢体远近两端的放射痛。
2.4出现四种神经体征中的两种征象(肌肉萎缩、运动无力、感觉减退和反射减弱)。
2.5与临床检查一致水平的影像学检查发现,包括椎管造影、CT或MRI等。
3纳入标准：
3.1符合LLDH诊断标准者；
3.2年龄在25～65岁之间；
3.3 CT/MRI检查示L4/L5、L5/S1节段腰椎间盘突出者。
4排除标准：
4.1腰椎骨折、肿瘤、结核、感染、手术后等破坏腰椎后部正常解剖结构等疾病；
4.2马尾神经综合症及双下肢瘫痪的患者;
4.3非L4/L5、L5/S1节段腰椎间盘突出者。
5资料分组：
350例按病情分为对照组和实验组；按性别差异分为男、女组；按年龄分为25-34岁组、35-44岁组、45-54岁组、54-65岁组。
6测量参数：
6.1棘突偏斜角：即棘突(中心线)与矢状面的偏斜角。同时记录棘突偏向突出间盘同侧,对侧或中央突出；
6.2关节突关节角(transverse interfacet angel法)：CT扫描要求平行终板,取椎间盘前后左右缘切线围成的长方形中心为椎间盘中心。取棘突基部中心与椎间盘中心连线为腰椎矢状轴,关节突关节面内外端点连线与腰椎矢状轴夹角为关节突关节角。两侧关节突关节形态不同或两侧关节突关节角度之差≥10°定义为关节突关节不对称,同时记录关节突的非对称性及椎间盘突出分型；
6.3腰椎曲度角(Cobb’s法)：即T12下缘切线延长线与S1上缘切线延长线所成的角；
6.4腰骶关节角(Gronkopff法)：在腰椎侧位片上L5椎体上下缘的中央连线和Sl椎体上下缘的中央连线相交所成的角,参考值范围为143°：
结果：
1病例组与对照组的棘突偏斜角在L4、L5水平存在差异,数据不呈正太分布,应用轶和检验,Z值为-10.609,-12.074 P<0.01。
2病例组与对照组的关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在各年龄组及总体比较无显著性差异,P>0.05。
3从性别上看,男、女组仅在腰骶关节角上有显著性差异,P=0.007<0.01；从年龄段间比较,关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在56～65岁组分别于25～35岁组、36～45岁组之间比较有显著差异性,(P<0.01),在46-55岁组和25-35岁组组之间有显著差异性,(P<0.01)。
结论：
本组研究显示腰椎骨性结构参数的变异不是直接导致腰椎间盘突出症的发病原因,但腰椎骨性结构参数的异常在腰椎间盘的退行性改变中的作用是不可否认的。
Objective:To measure and compare the construction parameters of lumbar spine bone structure in low lumbar disc herniation(LLDH) and to analyze dependability between changes of texture Parameters of lumbar vertebra and LLDH.the study was to investigate whether abnomalities of lumbar bony structure could lead to LLDH and to evaluate the importance of degeneration in degenerative lumbar disc.
Materials and Methods:
1 Date and case:2006 to 2008 hospitalizes in the orthopedics of the Affiliated Hospital of PuTian University with LLDH has 485 case,Screened 207 case of LLDH were randomly selected from them for the case group,143 cases of lumbar intervertebra disc unprotrusion were randomly selected from the patients with lumbar spine CT examinations in our hospital for the control group..
2 Diagnostic criteria for lumbar disc herniation (according to Hu have proposed diagnostic criteria Valley):
2.1 Leg suffers from the pain more then low spine which is the typical pain of the distribution area of sciatic nerve;
2.2 The skin which the area distributed sciatic nerve feels numbness;
2.3 Compared with the normal Lasegue-test reducing by 50%; and or the normal lasegue-test was positive,the radiating pain for whole leg caused by the Bowstring test;
2.4 Nervous signs appeared in two of four signs (muscle atrophy, motor weakness, sensory loss and reflex decreased).
3 Internalize standard:
3.1 The patients meet the diagnostic criteria of the LLDH;
3.2 Age range 25 to 65 years old;
3.3 Lumbar disc herniation occurs at the L4/5 and L5/S1.
4 Exclusion standard:
4.1 Vertebral fracture, tumor, tuberculosis, infection,after surgery such as destruction of normal anatomy of posterior lumbar spine and other diseases;
4.2 Cauda equina syndrome and patients with lower limb paralysi;
4.3 Lumbar disc herniation did not occur at the L4/5 and L5/S1.
5 Data Packet
350 cases classified patient group and control group according to the information of pathogenetic condition;According to ages,divide it into 25 to 35 group;36 to 45 group;46 to55
6 Parameter measurement
6.1 Spinous process deflection angle:the spinous process (centerline) and the sagittal plane of the deflection angle (see figure 1). At the same time tend to highlight the inter-disc recording spinous ipsilateral, contralateral or central prominence;
6.2 Facet joint angle (transverse interfacet angel France):CT scan of parallel end-plates, taken all around edge of disc tangent center surrounded by a rectangular disc center. Take spinous process base center and center connection for lumbar intervertebral disc sagittal axis, Facet endpoint connections within and outside the sagittal axis angle and lumbar facet joint angle for the (d). Both sides of the facet joint morphology different and (or) both sides of the facet joint angle difference≥10°is defined as the facet joint asymmetry, while recording the non-symmetry of facet joints and the disc sub-type;
6.3 Lumbar vertebrae curvature (Seze'S method):The forthcoming T12-S1 posterior margin of the formation of an arc-arc connection, measuring the distance from the top of the strings shall lumbar curvature;
6.4 Angle of lumbar vertebrae curvature (Cobb, s law) that the T12 tangent to extend the line and the lower edge of the upper edge of S1 to extend the lines into the tangent of the angle;
6.5 Lumbosacral angle (Gronkopff method):In the L5 lumbar vertebra on the lateral view the upper and lower edge of the central connection, and S1 vertebrae to connect the upper and lower edge of the central government into a corner of the intersection of the reference value range of 143°.
Results
1 Process deflection angle at L4, L5 levels had a significant statistical difference between the prominent group and the control. The date showed normal distribution.Using Rank sum test,it had a significant statistical difference (Z=-10.609,-12.074,P<0.01).
2 The analysis show that there was not significant statistical difference(P=0.065 >0.05) compared the patient group and the control group on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle.
3 There only was significant difference on Lumbosacral angle between male group and female group (P=0.007<0.01);There was significant difference on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 54-65 age group and 25-34 age group or 35-44 age group (P<0.01);There was significant differenceon the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 45-54 age group and 25-34 age group (P=0.0056<0.01).
Conclusion:This group of studies have shown that the abnomalities of lumbar bony structure could not lead the lumbar disc herniation;But the abnomalities of lumbar bony structure aggravate the lumbar intervertebral disc degenerative.
通过对下腰椎间盘突出症(Low Lumber Disc Herination, LLDH)患者腰椎骨性结构参数的测量和比较,分析这些参数的变化和LLDH的相关关系。探讨腰椎骨性结构的异常是否为腰椎间盘突出症的病因,以及在腰椎间盘退行性变中的意义。
方法：
1资料的收集：
2008-2010年收住莆田学院附属医院骨科的腰椎间盘突出症患者485例,随机抽取符合纳入标准的207例作为实验组；2008-2010年因慢性腰腿痛就诊我院骨科门诊患者700例,随机抽取符合纳入标准及CT检查显示无腰椎间盘突出者143例作为对照组。
2腰椎间盘突出症的诊断标准(依据胡有谷提出的诊断标准)：
2.1腿痛重于腰痛,腿痛呈典型的坐骨神经分布区域的疼痛。
2.2按神经分布区域的皮肤感觉麻木。
2.3直腿抬高较正常减少50%,兼或有好腿抬高试验阳性,作弓弦试验即胭窝区域指压胫神经引起肢体远近两端的放射痛。
2.4出现四种神经体征中的两种征象(肌肉萎缩、运动无力、感觉减退和反射减弱)。
2.5与临床检查一致水平的影像学检查发现,包括椎管造影、CT或MRI等。
3纳入标准：
3.1符合LLDH诊断标准者；
3.2年龄在25～65岁之间；
3.3 CT/MRI检查示L4/L5、L5/S1节段腰椎间盘突出者。
4排除标准：
4.1腰椎骨折、肿瘤、结核、感染、手术后等破坏腰椎后部正常解剖结构等疾病；
4.2马尾神经综合症及双下肢瘫痪的患者;
4.3非L4/L5、L5/S1节段腰椎间盘突出者。
5资料分组：
350例按病情分为对照组和实验组；按性别差异分为男、女组；按年龄分为25-34岁组、35-44岁组、45-54岁组、54-65岁组。
6测量参数：
6.1棘突偏斜角：即棘突(中心线)与矢状面的偏斜角。同时记录棘突偏向突出间盘同侧,对侧或中央突出；
6.2关节突关节角(transverse interfacet angel法)：CT扫描要求平行终板,取椎间盘前后左右缘切线围成的长方形中心为椎间盘中心。取棘突基部中心与椎间盘中心连线为腰椎矢状轴,关节突关节面内外端点连线与腰椎矢状轴夹角为关节突关节角。两侧关节突关节形态不同或两侧关节突关节角度之差≥10°定义为关节突关节不对称,同时记录关节突的非对称性及椎间盘突出分型；
6.3腰椎曲度角(Cobb’s法)：即T12下缘切线延长线与S1上缘切线延长线所成的角；
6.4腰骶关节角(Gronkopff法)：在腰椎侧位片上L5椎体上下缘的中央连线和Sl椎体上下缘的中央连线相交所成的角,参考值范围为143°：
结果：
1病例组与对照组的棘突偏斜角在L4、L5水平存在差异,数据不呈正太分布,应用轶和检验,Z值为-10.609,-12.074 P<0.01。
2病例组与对照组的关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在各年龄组及总体比较无显著性差异,P>0.05。
3从性别上看,男、女组仅在腰骶关节角上有显著性差异,P=0.007<0.01；从年龄段间比较,关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在56～65岁组分别于25～35岁组、36～45岁组之间比较有显著差异性,(P<0.01),在46-55岁组和25-35岁组组之间有显著差异性,(P<0.01)。
结论：
本组研究显示腰椎骨性结构参数的变异不是直接导致腰椎间盘突出症的发病原因,但腰椎骨性结构参数的异常在腰椎间盘的退行性改变中的作用是不可否认的。
Objective:To measure and compare the construction parameters of lumbar spine bone structure in low lumbar disc herniation(LLDH) and to analyze dependability between changes of texture Parameters of lumbar vertebra and LLDH.the study was to investigate whether abnomalities of lumbar bony structure could lead to LLDH and to evaluate the importance of degeneration in degenerative lumbar disc.
Materials and Methods:
1 Date and case:2006 to 2008 hospitalizes in the orthopedics of the Affiliated Hospital of PuTian University with LLDH has 485 case,Screened 207 case of LLDH were randomly selected from them for the case group,143 cases of lumbar intervertebra disc unprotrusion were randomly selected from the patients with lumbar spine CT examinations in our hospital for the control group..
2 Diagnostic criteria for lumbar disc herniation (according to Hu have proposed diagnostic criteria Valley):
2.1 Leg suffers from the pain more then low spine which is the typical pain of the distribution area of sciatic nerve;
2.2 The skin which the area distributed sciatic nerve feels numbness;
2.3 Compared with the normal Lasegue-test reducing by 50%; and or the normal lasegue-test was positive,the radiating pain for whole leg caused by the Bowstring test;
2.4 Nervous signs appeared in two of four signs (muscle atrophy, motor weakness, sensory loss and reflex decreased).
3 Internalize standard:
3.1 The patients meet the diagnostic criteria of the LLDH;
3.2 Age range 25 to 65 years old;
3.3 Lumbar disc herniation occurs at the L4/5 and L5/S1.
4 Exclusion standard:
4.1 Vertebral fracture, tumor, tuberculosis, infection,after surgery such as destruction of normal anatomy of posterior lumbar spine and other diseases;
4.2 Cauda equina syndrome and patients with lower limb paralysi;
4.3 Lumbar disc herniation did not occur at the L4/5 and L5/S1.
5 Data Packet
350 cases classified patient group and control group according to the information of pathogenetic condition;According to ages,divide it into 25 to 35 group;36 to 45 group;46 to55
6 Parameter measurement
6.1 Spinous process deflection angle:the spinous process (centerline) and the sagittal plane of the deflection angle (see figure 1). At the same time tend to highlight the inter-disc recording spinous ipsilateral, contralateral or central prominence;
6.2 Facet joint angle (transverse interfacet angel France):CT scan of parallel end-plates, taken all around edge of disc tangent center surrounded by a rectangular disc center. Take spinous process base center and center connection for lumbar intervertebral disc sagittal axis, Facet endpoint connections within and outside the sagittal axis angle and lumbar facet joint angle for the (d). Both sides of the facet joint morphology different and (or) both sides of the facet joint angle difference≥10°is defined as the facet joint asymmetry, while recording the non-symmetry of facet joints and the disc sub-type;
6.3 Lumbar vertebrae curvature (Seze'S method):The forthcoming T12-S1 posterior margin of the formation of an arc-arc connection, measuring the distance from the top of the strings shall lumbar curvature;
6.4 Angle of lumbar vertebrae curvature (Cobb, s law) that the T12 tangent to extend the line and the lower edge of the upper edge of S1 to extend the lines into the tangent of the angle;
6.5 Lumbosacral angle (Gronkopff method):In the L5 lumbar vertebra on the lateral view the upper and lower edge of the central connection, and S1 vertebrae to connect the upper and lower edge of the central government into a corner of the intersection of the reference value range of 143°.
Results
1 Process deflection angle at L4, L5 levels had a significant statistical difference between the prominent group and the control. The date showed normal distribution.Using Rank sum test,it had a significant statistical difference (Z=-10.609,-12.074,P<0.01).
2 The analysis show that there was not significant statistical difference(P=0.065 >0.05) compared the patient group and the control group on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle.
3 There only was significant difference on Lumbosacral angle between male group and female group (P=0.007<0.01);There was significant difference on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 54-65 age group and 25-34 age group or 35-44 age group (P<0.01);There was significant differenceon the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 45-54 age group and 25-34 age group (P=0.0056<0.01).
Conclusion:This group of studies have shown that the abnomalities of lumbar bony structure could not lead the lumbar disc herniation;But the abnomalities of lumbar bony structure aggravate the lumbar intervertebral disc degenerative.
引文
1 Heliovaara MBody heigh obesity and risk of herniated lumbar inter vertebral disc[J]. Spine, 1987,12:469.
2张寿涛.腰椎间盘突出症的多因素分析.山东大学,2005年硕士毕业论文。
3 Cooke, etal. Internal disc disruption and axial back pain in the athlete[J]. Phys-Med-Rehabil-Clin-N-Am.2000,11:837-65.
4孙西河,王滨,陈景武等.腰椎间盘突出症影响因素的逐步判别分析[J]。潍坊医学院学报.2001,23(4)：255—257。
5 Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumber facet joins L1. L5 in elderly individuals [J]. Eur Spine,2006,15(3):308-315.
6 Van Schaik JP. Lumbar facet ioInt morphologyEJ]. Soinal Disord,2000,13(1):88-89.
7 Niosi CA, Oxland TR. Degenerative mechanics of the lumb arspine[J]. Spine J,2004,4(6): 202-208.
8谭映军,潘显明,张波,等。腰椎间盘摘除前后椎间关节内应力变化的实验研究[J]。骨与关节损伤杂志,2001,16(1)：31-32。
9 Berven S, Tay BB, Colman W, et al. The lumbar zygapophyseal joints:a role in the paphegenesis of spinal painsyndromes and degenerative soondylolisthesis[J]. Semin Neural,2002,22(1): 187-196.
10李华,侯筱魁,洪钟瑜,等.腰椎关节突关节和椎间盘内应力测量方法的研究[J].医用生物力学,2001,16(1)：34—37。
11胡有谷主编。腰椎间盘突出症。第二版。北京：人民卫生出版社,1995；221。
12. Ishihara H. Matsui H. Osada R Facet joint asymmetry as a radiologic feature of lumbar inter vertebral disc herniation in children and adolescents 1997,22(17)2001-2004
13阮狄克,何勃,丁宇。脊柱肿瘤切除术后稳定性重建[J].中国矫形外科杂志,2002,10(9)：843—846。
14 Yong Hing K, Willis WH. The three-joint comPlex. in:Weinstein JN, Wiesed SW, eds. The lumber spine[J]. lsted. Dhiladehio:WBsounders comany,1990:80-87
15 Haher TR,O, Brien M, Dryer JW. etal. The role of the lumbar facet ioints in spinal stability. Identification of alternative paths of Ioading[J]. Spine,1994.19(23):2667-2671.
16 Sharma M. Langrana NA. Rodriguez J. Role of lipamerits and facets in lumbar spinal stability[J]. Spine.1995.20(8):887-900.
17 Van Schaik J, Verbiest H, Van Schaik F. The o rientation of lam inae and facet joint in the lower lumbar spine [J]. Spine,1985,10:59-63.
18盂庆兰腰椎关节面方位角变化规律及其临床意义[J]。中国临床解剖学杂志,2002,20(4)：283。
19吴阶平,裘法祖,主编.黄家驷外科学.第5版。北京：人民卫生出版社,1992.2507。
20李晓光,张明.实用骨与关节x线测量.济南：山东科学技术出版社,1996 188。
21金柏军,钱宇,徐国健.下腰痛患者与腰椎前凸度及骶骨倾斜度的关系.中国脊柱脊髓杂志,2004,14(6)：364。
22李海.腰椎棘间韧带退行性改变的组织学观察与腰椎间盘突出症发病关系的研究：[硕士学位论文].保存地点：山东中医药大学,2004.7
23程延,张丽心,杨富国,等.腰椎间盘突出症发病的生物力学基础研究进展[J].陕西中医函授,2002,(1)：35—37.
24戴力扬腰椎关节突关节的床解剖；中国临床解剖学杂志,1991,9(3)；179-182。
25 Loback D. Young-Hing K. Cassidy JD The relationship between facet orientation and lumbar disc herniation:the role of torsion in intervertebral disc failure 2005.
26张光铂、绳厚福。史振才腰椎关节突关节不对称与椎间盘变性1997(5)。
27卢定友,顾建华,孙维高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究.临床放射学杂志,2003,22(4)：343～344。
28于红,侯树君,吴闻文,等。下腰椎小关节的方向与椎间盘突出和侧隐窝狭窄的关系[J].中华外科杂志,1998.36(3)：176～178。
29周秉文,腰背痛[M]第1版,北京：人民卫生出版社,1991.5-7。
30王亦璁,孟继懋,郭子恒,骨与关节损伤[M]第2版,北京：人民卫生出版社,1991.496-498
31黄友锦,卓启瑶,丁中平,等.腰椎间盘突出症腰椎关节突关节的CT分析[J]实用放射学杂志2003,19(4)：373-374.
32卢定友9,顾建华,孙为高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究[J]临床放射学杂志,2003,22(4)：343-344。
33黄建华,陈金春,徐卫国。腰椎关节突关节角不对称与椎间盘变性的相关性[J]。中医正骨,2006。8(18)：27～29。
34杨克勤。脊柱疾患的临床与研究。北京。北京出版社,1993.619—627。
35 WhiteAA. A biomechanical analysis of clinieal stability of the lumbar and lumbo-sacral spine. Spine,2002,7:374.
36陆裕朴,等。实用骨科学。北京：人民军医出版社,1991.1150.
37汪青春,田明波,李钦宗,等.低位腰椎间盘突出症患者腰椎结构参数变化及其临床意义[J]。安徽中医学院学报,2006,25(6)：47-49
38 JonesNA, GonzalezAC. Ultrasono graphic determination of lumbar spine angulation[J].AnatReec 1981,199(2):281-286.
39巧王青,冷启刚。90例正常人骨盆倾斜度测量结果分析[J].山东医药,1998,8(38)：31.
40胥少汀 葛宝丰 徐印。实用骨科学第三版。北京：人民军医出版社2006.545。
1 Maenab I Nenative disce exploration an analysis of the causes of nerve roof involvement in sixty-eight patients [J].J bone Joint surg (Am),1971,53(5):891891-893.
2王安庆.下腰痛的诊断与康复.中国康复理论与实践,2002,8(4)：197—217.
3 Nickel R, Egle UT, Eysel P.Health-Related Quality of Life and Somatization in Patients With Long-Tenn Low Back Pain:A Prospective Study With 109 Patients.sPine,2001,26(20):2271-2277.
4周秉文.腰背痛(第二版),北京,人民卫生出版社,2006.
5 Radebold A, CholewichiJ, Polzhofer GK.IInPaired Postural Control of the Lumbar Spine is Assoeiated With Delayed Muscle Response Times in Patients With Chronic Idiopathic Low Back Pain.Spine,2001, 26(7):724-730.
6 Leinonen, Ville, Kankaan Paa, Marhmd.Lumber Para spinal Musel Funection, Perception of Lumbar Position, and Postural Control in Disc Hen 五 ation-Related Back pain.Spine, 2003,28(8):842-848.
7 Leinonen, VilleBM, KankaanPaa, Markku DMSe.DiseHemiation-Related Back Pain Impairs Feed-Forward Control of Para spinal Museles. Spine,2001,26(16):367-372.
8 Van Dieen, Jeep H, M. Dekkers.Within-Subject Variability in Low Back Load In a Repetitively Performed, Mildly Constrained Lifting Task.Spine,2001,26(16):1799-1804.
9 Hukuda S, Minami M, Saito T, Mitsui H, Matsui N.SpondyloarthroPathies in Japan:nationwide questionnaire survey Peribrmed by the Japan Anky losing Spondy litis Society. J Rheumatol,2001, 28(3):554-9.
10 J Hartvigsen, K Kyvik, C Leboeuf-Yde.Ambiguous relation between Physical Workload and low back Pain:a twin conirol study.Occupational and Environment Medieine,2003,60:109-114.
11 Papageorgiou, AM C, Maefarlane, Gary J, Thomas.Psychosocial Faetors in the Workplace-DoThey Prediet New EPisodes of Low Back Pain:Evidence From The South Manchester Back Pain Study, SPine, 1997,22(10):1137-1142.
12 George, Steven2.Fritz, Julie, Ethard, Richard E.DC. Acomparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervieal Spine Pain.Spine,2001,26(19):2139-2145.
13 Kermit GDavisa, Catherine A.Heaneyb.There lation ship between Psychosocial work characteristics and low back Pain underlying methodological issucs.Clinical Biomeehanies,2000,15:389-406e
14 Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumber facet joins LI. L5 in elderly individuals[J]. Eur Spine,2006,15(3):308-315.
15 VanSchaik JP. Lumbar facet iolnt morphologyEJ]. Soinal Disord,2000,13(1):88-89.
16 Niosi CA, Oxland TR. Degenerative mechanics of the lumb an spine[J]. Spine J,2004,4(6):202-208.
17谭映军,潘显明,张波,等。腰椎间盘摘除前后椎间关节内应力变化的实验研究[J]。.骨与关节损伤杂志,2001,16(1)：31～32。
18 Berven S, Tay BB, Colman W, et al. The lumbar zygapophyseal joints:a role in the paphegenesis of spinal painsyndromes and degenerative soondylolisthesis[J]. Semin Neural,2002,22(1):187-196.
19李华,侯筱魁,洪钟瑜,等.腰椎关节突关节和椎间盘内应力测量方法的研究[J].医用生物力学,2001,16(1)：34—37。
20戴力扬 腰椎关节突关节的临床解剖[J]；中国临床解剖学杂志,1991,9(3)；179-182。
21 Loback D.Young-Hing K.Cassidy JD The relationship between facet orientation and lumbar disc herniation:the role of torsion in intervertebral disc failure 1985.
22张光铂、绳厚福。史振才腰椎关节突关节不对称与椎间盘变性1997(5)。
23王亦璁,孟继懋,郭子恒,骨与关节损伤[M]第2版,北京：人民卫生出版社,1991.496-498
24黄友锦,卓启瑶,丁中平,等.腰椎间盘突出症腰椎关节突关节的CT分析[J]实用放射学杂志2003,19(4)：373-374.
25卢定友9,顾建华,孙为高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究[J]临床放射学杂志,2003,22(4)：343-344。
26黄建华,陈金春,徐卫国。腰椎关节突关节角不对称与椎间盘变性的相关性。中医正骨,2006。8(18)：27～29。
27杨克勤。脊柱疾患的临床与研究。北京。北京出版社,1993.619—627。
28 WhiteAA.A biomechanical analysis of clinical stability of the lumbar and lumbor-sacral spine. Spine, 1982,7:374.
29陆裕朴,等。实用骨科学。北京：人民军医出版社,1991.1150.
30汪青春,田明波,李钦宗,等.低位腰椎间盘突出症患者腰椎结构参数变化及其临床意义.安徽中医学院学报,2006,25(6)：47碑9.
31 JonesNA, GonzalezAC.UltrasonograPhiedetermination of lumbar spine angulation [J].Anat Ree,1981,199(2):281-286.
32金柏军,钱宇,徐国健.下腰痛患者与腰椎前凸度及骶骨倾斜度的关系.中国脊柱脊髓杂志,2004,14(6)：364.
33胥少汀,葛宝丰,徐印.《实用骨,科学》第三版.北京：人民军医出版社,2006.545.
2张寿涛.腰椎间盘突出症的多因素分析.山东大学,2005年硕士毕业论文。
3 Cooke, etal. Internal disc disruption and axial back pain in the athlete[J]. Phys-Med-Rehabil-Clin-N-Am.2000,11:837-65.
4孙西河,王滨,陈景武等.腰椎间盘突出症影响因素的逐步判别分析[J]。潍坊医学院学报.2001,23(4)：255—257。
5 Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumber facet joins L1. L5 in elderly individuals [J]. Eur Spine,2006,15(3):308-315.
6 Van Schaik JP. Lumbar facet ioInt morphologyEJ]. Soinal Disord,2000,13(1):88-89.
7 Niosi CA, Oxland TR. Degenerative mechanics of the lumb arspine[J]. Spine J,2004,4(6): 202-208.
8谭映军,潘显明,张波,等。腰椎间盘摘除前后椎间关节内应力变化的实验研究[J]。骨与关节损伤杂志,2001,16(1)：31-32。
9 Berven S, Tay BB, Colman W, et al. The lumbar zygapophyseal joints:a role in the paphegenesis of spinal painsyndromes and degenerative soondylolisthesis[J]. Semin Neural,2002,22(1): 187-196.
10李华,侯筱魁,洪钟瑜,等.腰椎关节突关节和椎间盘内应力测量方法的研究[J].医用生物力学,2001,16(1)：34—37。
11胡有谷主编。腰椎间盘突出症。第二版。北京：人民卫生出版社,1995；221。
12. Ishihara H. Matsui H. Osada R Facet joint asymmetry as a radiologic feature of lumbar inter vertebral disc herniation in children and adolescents 1997,22(17)2001-2004
13阮狄克,何勃,丁宇。脊柱肿瘤切除术后稳定性重建[J].中国矫形外科杂志,2002,10(9)：843—846。
14 Yong Hing K, Willis WH. The three-joint comPlex. in:Weinstein JN, Wiesed SW, eds. The lumber spine[J]. lsted. Dhiladehio:WBsounders comany,1990:80-87
15 Haher TR,O, Brien M, Dryer JW. etal. The role of the lumbar facet ioints in spinal stability. Identification of alternative paths of Ioading[J]. Spine,1994.19(23):2667-2671.
16 Sharma M. Langrana NA. Rodriguez J. Role of lipamerits and facets in lumbar spinal stability[J]. Spine.1995.20(8):887-900.
17 Van Schaik J, Verbiest H, Van Schaik F. The o rientation of lam inae and facet joint in the lower lumbar spine [J]. Spine,1985,10:59-63.
18盂庆兰腰椎关节面方位角变化规律及其临床意义[J]。中国临床解剖学杂志,2002,20(4)：283。
19吴阶平,裘法祖,主编.黄家驷外科学.第5版。北京：人民卫生出版社,1992.2507。
20李晓光,张明.实用骨与关节x线测量.济南：山东科学技术出版社,1996 188。
21金柏军,钱宇,徐国健.下腰痛患者与腰椎前凸度及骶骨倾斜度的关系.中国脊柱脊髓杂志,2004,14(6)：364。
22李海.腰椎棘间韧带退行性改变的组织学观察与腰椎间盘突出症发病关系的研究：[硕士学位论文].保存地点：山东中医药大学,2004.7
23程延,张丽心,杨富国,等.腰椎间盘突出症发病的生物力学基础研究进展[J].陕西中医函授,2002,(1)：35—37.
24戴力扬腰椎关节突关节的床解剖；中国临床解剖学杂志,1991,9(3)；179-182。
25 Loback D. Young-Hing K. Cassidy JD The relationship between facet orientation and lumbar disc herniation:the role of torsion in intervertebral disc failure 2005.
26张光铂、绳厚福。史振才腰椎关节突关节不对称与椎间盘变性1997(5)。
27卢定友,顾建华,孙维高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究.临床放射学杂志,2003,22(4)：343～344。
28于红,侯树君,吴闻文,等。下腰椎小关节的方向与椎间盘突出和侧隐窝狭窄的关系[J].中华外科杂志,1998.36(3)：176～178。
29周秉文,腰背痛[M]第1版,北京：人民卫生出版社,1991.5-7。
30王亦璁,孟继懋,郭子恒,骨与关节损伤[M]第2版,北京：人民卫生出版社,1991.496-498
31黄友锦,卓启瑶,丁中平,等.腰椎间盘突出症腰椎关节突关节的CT分析[J]实用放射学杂志2003,19(4)：373-374.
32卢定友9,顾建华,孙为高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究[J]临床放射学杂志,2003,22(4)：343-344。
33黄建华,陈金春,徐卫国。腰椎关节突关节角不对称与椎间盘变性的相关性[J]。中医正骨,2006。8(18)：27～29。
34杨克勤。脊柱疾患的临床与研究。北京。北京出版社,1993.619—627。
35 WhiteAA. A biomechanical analysis of clinieal stability of the lumbar and lumbo-sacral spine. Spine,2002,7:374.
36陆裕朴,等。实用骨科学。北京：人民军医出版社,1991.1150.
37汪青春,田明波,李钦宗,等.低位腰椎间盘突出症患者腰椎结构参数变化及其临床意义[J]。安徽中医学院学报,2006,25(6)：47-49
38 JonesNA, GonzalezAC. Ultrasono graphic determination of lumbar spine angulation[J].AnatReec 1981,199(2):281-286.
39巧王青,冷启刚。90例正常人骨盆倾斜度测量结果分析[J].山东医药,1998,8(38)：31.
40胥少汀 葛宝丰 徐印。实用骨科学第三版。北京：人民军医出版社2006.545。
1 Maenab I Nenative disce exploration an analysis of the causes of nerve roof involvement in sixty-eight patients [J].J bone Joint surg (Am),1971,53(5):891891-893.
2王安庆.下腰痛的诊断与康复.中国康复理论与实践,2002,8(4)：197—217.
3 Nickel R, Egle UT, Eysel P.Health-Related Quality of Life and Somatization in Patients With Long-Tenn Low Back Pain:A Prospective Study With 109 Patients.sPine,2001,26(20):2271-2277.
4周秉文.腰背痛(第二版),北京,人民卫生出版社,2006.
5 Radebold A, CholewichiJ, Polzhofer GK.IInPaired Postural Control of the Lumbar Spine is Assoeiated With Delayed Muscle Response Times in Patients With Chronic Idiopathic Low Back Pain.Spine,2001, 26(7):724-730.
6 Leinonen, Ville, Kankaan Paa, Marhmd.Lumber Para spinal Musel Funection, Perception of Lumbar Position, and Postural Control in Disc Hen 五 ation-Related Back pain.Spine, 2003,28(8):842-848.
7 Leinonen, VilleBM, KankaanPaa, Markku DMSe.DiseHemiation-Related Back Pain Impairs Feed-Forward Control of Para spinal Museles. Spine,2001,26(16):367-372.
8 Van Dieen, Jeep H, M. Dekkers.Within-Subject Variability in Low Back Load In a Repetitively Performed, Mildly Constrained Lifting Task.Spine,2001,26(16):1799-1804.
9 Hukuda S, Minami M, Saito T, Mitsui H, Matsui N.SpondyloarthroPathies in Japan:nationwide questionnaire survey Peribrmed by the Japan Anky losing Spondy litis Society. J Rheumatol,2001, 28(3):554-9.
10 J Hartvigsen, K Kyvik, C Leboeuf-Yde.Ambiguous relation between Physical Workload and low back Pain:a twin conirol study.Occupational and Environment Medieine,2003,60:109-114.
11 Papageorgiou, AM C, Maefarlane, Gary J, Thomas.Psychosocial Faetors in the Workplace-DoThey Prediet New EPisodes of Low Back Pain:Evidence From The South Manchester Back Pain Study, SPine, 1997,22(10):1137-1142.
12 George, Steven2.Fritz, Julie, Ethard, Richard E.DC. Acomparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervieal Spine Pain.Spine,2001,26(19):2139-2145.
13 Kermit GDavisa, Catherine A.Heaneyb.There lation ship between Psychosocial work characteristics and low back Pain underlying methodological issucs.Clinical Biomeehanies,2000,15:389-406e
14 Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumber facet joins LI. L5 in elderly individuals[J]. Eur Spine,2006,15(3):308-315.
15 VanSchaik JP. Lumbar facet iolnt morphologyEJ]. Soinal Disord,2000,13(1):88-89.
16 Niosi CA, Oxland TR. Degenerative mechanics of the lumb an spine[J]. Spine J,2004,4(6):202-208.
17谭映军,潘显明,张波,等。腰椎间盘摘除前后椎间关节内应力变化的实验研究[J]。.骨与关节损伤杂志,2001,16(1)：31～32。
18 Berven S, Tay BB, Colman W, et al. The lumbar zygapophyseal joints:a role in the paphegenesis of spinal painsyndromes and degenerative soondylolisthesis[J]. Semin Neural,2002,22(1):187-196.
19李华,侯筱魁,洪钟瑜,等.腰椎关节突关节和椎间盘内应力测量方法的研究[J].医用生物力学,2001,16(1)：34—37。
20戴力扬 腰椎关节突关节的临床解剖[J]；中国临床解剖学杂志,1991,9(3)；179-182。
21 Loback D.Young-Hing K.Cassidy JD The relationship between facet orientation and lumbar disc herniation:the role of torsion in intervertebral disc failure 1985.
22张光铂、绳厚福。史振才腰椎关节突关节不对称与椎间盘变性1997(5)。
23王亦璁,孟继懋,郭子恒,骨与关节损伤[M]第2版,北京：人民卫生出版社,1991.496-498
24黄友锦,卓启瑶,丁中平,等.腰椎间盘突出症腰椎关节突关节的CT分析[J]实用放射学杂志2003,19(4)：373-374.
25卢定友9,顾建华,孙为高,等。下腰椎小关节突方向非对称性与椎间盘突出方向关系的研究[J]临床放射学杂志,2003,22(4)：343-344。
26黄建华,陈金春,徐卫国。腰椎关节突关节角不对称与椎间盘变性的相关性。中医正骨,2006。8(18)：27～29。
27杨克勤。脊柱疾患的临床与研究。北京。北京出版社,1993.619—627。
28 WhiteAA.A biomechanical analysis of clinical stability of the lumbar and lumbor-sacral spine. Spine, 1982,7:374.
29陆裕朴,等。实用骨科学。北京：人民军医出版社,1991.1150.
30汪青春,田明波,李钦宗,等.低位腰椎间盘突出症患者腰椎结构参数变化及其临床意义.安徽中医学院学报,2006,25(6)：47碑9.
31 JonesNA, GonzalezAC.UltrasonograPhiedetermination of lumbar spine angulation [J].Anat Ree,1981,199(2):281-286.
32金柏军,钱宇,徐国健.下腰痛患者与腰椎前凸度及骶骨倾斜度的关系.中国脊柱脊髓杂志,2004,14(6)：364.
33胥少汀,葛宝丰,徐印.《实用骨,科学》第三版.北京：人民军医出版社,2006.545.