小关节角度和不对称性在L<sub>4～5</sub>退变性滑脱发生中的作用

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摘要目的探讨小关节角度(facet joint angle，FJA)和小关节不对称性(facet tropism，FT)在退行性腰椎滑脱(degenerative lumbar spondylolisthesis，DLS)发生中的作用。方法 DLS组：共选取50例自2016年1月至2017年12月在我院治疗的患者，其中男18例，女32例；44~85岁，平均年龄为(63.94±9.96)岁。对照组：同期在我院住院或门诊就诊、腰椎CT及MRI显示无明显异常、仅有腰椎退行性改变的50例患者，其中男22例，女28例；42~81岁，平均年龄为(62.04±11.42)岁。在CT上测量每个患者L_3～4、L_4～5和L₅S₁节段FJA。根据Pfirrmann分级在MRI上评估椎间盘退变程度。用独立样本 t 检验比较DLS组与正常人组之间FJA的差异。用Mann-Whitney U检验比较两组各节段椎间盘退变分级是否有差异。结果 DLS组与正常组相比较，L_3～4、L_4～5和L₅S₁节段上，椎间盘退变程度分级差异均无统计学意义(P值分别为0.641，0.953，0.795)。在L_4～5节段上，两组之间FJA比较差异有统计学意义(P＜0.001)；在L_3～4节段上，两组之间FJA比较差异有统计学意义(P＝0.002)；在L₅ S₁节段上，两组之间FJA比较差异无统计学意义(P＝0.903)。结论 FT是DLS发生的危险因素，DLS患者较正常人具有更加矢状化的FJA，我们倾向于认为这是DLS中小关节(facetjoint，FJ)发生二次重塑的结果。

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	郭马超
	鲁世保 *
	孔超

关键词 ：小关节角度, 小关节不对称, 退变性腰椎滑脱

Abstract：

Objective To explore the role of facet joint angle(FJA)and facet tropism(FT)in degenerative lumbar spondylolisthesis(DLS).Methods In group DLS，50 patients were enrolled in our hospital from January 2016 to December 2017.There were18 male and 32 women，with an average age of(63.94±9.96)years.Control group had 50 patients from our inpatient ward or outpatient department.Lumbar CT showed no obvious abnormalities and only lumbar degenerative changes.There were a total of 50 patients，22 men and 28 women，with an average age of(62.05±11.42)years.In the DLS group，FJA of each patient at L_3～4，L_4～5and L₅S₁ was measured on CT.The independent sample t test was used to compare the difference of FJA between the DLS group and the normal group.Pfirrmann grading of intervertebral disc degeneration between the DLS and control groups were compared with the Mann-Whitney U test.Results The results of the Mann-Whitney U test demonstrated no significant difference in Pfirrmann grading at the L_3～4，L_4～5，and L₅S₁ levels between the DLS and control groups(p = 0.641，0.953，and 0.795，respectively).The DLS group was compared with the normal group，and there was a statistical difference between the two groups in the L_4～5(P＜0.001).There were statistical differences between the two groups in the L_3～4(P＝0.002).There was no statistical difference between the two groups in the L₅S₁(P＝0.903).Conclusion FT is a risk factor for the occurrence of DLS.DLS patients have more sagittal FJA than normal people.We tend to think that this is the result of the second reconstitution of FJ in the occurrence of DLS.

Key words： facet joint angle facet tropism degenerative lumbar spondylolisthesis

通讯作者: 鲁世保

作者简介: 郭马超(1990－ )，男，研究生在读，首都医科大学宣武医院骨科，100053。

引用本文:

郭马超，鲁世保 *，孔超. 小关节角度和不对称性在L_4～5退变性滑脱发生中的作用[J]. 实用骨科杂志, 2018, 24(7): 584-588.
Guo Machao，Lu Shibao *，Kong Chao. Facet Joint Angle and Facet Tropism in L_4~5 Degenerative Lumbar Spondylolisthesis. sygkzz, 2018, 24(7): 584-588.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I7/584

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