腰椎管狭窄症患者腰椎关节突关节退行性变化的MRI影像评估
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摘要
背景:腰椎管狭窄症是临床中常见病,其影像学表现及病因复杂,目前在腰椎关节突关节退变影像学方面研究较少,有待进一步探讨。目的:运用MRI观察腰椎管狭窄症患者腰椎小关节突骨性关节炎与腰椎小关节角的影像学变化,并分析两者之间的关系。方法:通过MRIT2WI横断面的观察,对120例腰椎管狭窄症患者L4/5、L5/S1节段双侧腰椎小关节角进行测量并评定两侧腰椎小关节突骨性关节炎等级,观察不同节段双侧腰椎小关节角与腰椎小关节突骨性关节炎MRI影像学变化,分析两者之间的关系。所有患者对检查方案知情同意,且得到医院伦理委员会批准。结果与结论:①L4/5、L5/S1同节段左右两侧腰椎小关节角差异有显著性意义(P<0.05);②在同节段不同等级腰椎小关节突骨性关节炎组间,双侧病例数比较差异无显著性意义(P> 0.05),而两侧腰椎小关节角差异有显著性意义(P <0.05);③两节段中腰椎小关节角与年龄、性别、体质量指数无相关性(P> 0.05),而性别、体质量指数与左侧腰椎小关节突骨性关节炎等级之间存在弱相关性(P <0.05),且腰椎小关节角与腰椎小关节突骨性关节炎等级之间成负等级相关(P <0.05);④结果提示,腰椎管狭窄症患者腰椎小关节角与腰椎小关节突骨性关节炎之间存在负相关关系。腰椎小关节突骨性关节炎越严重,腰椎小关节越偏向矢状位,两者病理改变是椎管狭窄的重要影像学特征,可为临床医师正确、深入认识椎旁结构退变对疾病的影响提供依据。
BACKGROUND: Lumbar spinal stenosis is a common disease in the clinic, and the imaging manifestations and etiology are complex. There are few studies on the degeneration of lumbar facet joints, which needs further investigation.OBJECTIVE: To investigate the relationship between lumbar facet joint arthritis and lumbar facet joint angle in cross-sectional observation of MRI in patients with lumbar spinal stenosis.METHODS: In T2 WI of MRI, L4/5 and L5/S1 segment bilateral lumbar facet joint angle of 120 patients with lumbar spinal stenosis was assessed and we measured the lumbar facet joint angle grade on both sides. Then, the changes of bilateral lumbar facet joint angle of different segments and lumbar facet joint angle MRI were observed. Finally, the relationship among them was analyzed. Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital.RESULTS AND CONCLUSION:(1) There were significant differences between L4/5 and L5/S1 in the angle of lumbar facet on the left and right sides of the same segment(P < 0.05).(2) There was no significant difference in the number of bilateral cases between lumbar facet joint angle groups with different grades of the same segment(P > 0.05), while there were significant differences in the angle of bilateral lumbar facet joints(P < 0.05).(3) For lumbar facet angle, it showed no correlation with age, gender and body mass index in the two segments(P > 0.05),while lumbar facet joint angle grade on the left showed little correlation with gender and body mass index(P < 0.05), and there was a negative correlation between lumbar facet angle and lumbar facet joint angle grade(P < 0.05).(4) In summary, there is a negative correlation between lumbar facet angle and lumbar facet joint angle in patients with lumbar spinal stenosis. The more severe lumbar facet joint angle is, the more sagittal the lumbar facet joint is. The pathological changes of them are important imaging features of spinal stenosis, providing evidence for clinicians to understand the influence of paravertebral structural degeneration correctly and deeply.
BACKGROUND: Lumbar spinal stenosis is a common disease in the clinic, and the imaging manifestations and etiology are complex. There are few studies on the degeneration of lumbar facet joints, which needs further investigation.OBJECTIVE: To investigate the relationship between lumbar facet joint arthritis and lumbar facet joint angle in cross-sectional observation of MRI in patients with lumbar spinal stenosis.METHODS: In T2 WI of MRI, L4/5 and L5/S1 segment bilateral lumbar facet joint angle of 120 patients with lumbar spinal stenosis was assessed and we measured the lumbar facet joint angle grade on both sides. Then, the changes of bilateral lumbar facet joint angle of different segments and lumbar facet joint angle MRI were observed. Finally, the relationship among them was analyzed. Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital.RESULTS AND CONCLUSION:(1) There were significant differences between L4/5 and L5/S1 in the angle of lumbar facet on the left and right sides of the same segment(P < 0.05).(2) There was no significant difference in the number of bilateral cases between lumbar facet joint angle groups with different grades of the same segment(P > 0.05), while there were significant differences in the angle of bilateral lumbar facet joints(P < 0.05).(3) For lumbar facet angle, it showed no correlation with age, gender and body mass index in the two segments(P > 0.05),while lumbar facet joint angle grade on the left showed little correlation with gender and body mass index(P < 0.05), and there was a negative correlation between lumbar facet angle and lumbar facet joint angle grade(P < 0.05).(4) In summary, there is a negative correlation between lumbar facet angle and lumbar facet joint angle in patients with lumbar spinal stenosis. The more severe lumbar facet joint angle is, the more sagittal the lumbar facet joint is. The pathological changes of them are important imaging features of spinal stenosis, providing evidence for clinicians to understand the influence of paravertebral structural degeneration correctly and deeply.
引文
[1]Du CF,Yang N,Guo JC,et al.Biomechanical response of lumbar facet joints under follower preload:a finite element study.BMC Musculoskelet Disord.2016;17(1):126.
[2]王洪岗.小关节方向不规则变化与腰椎间盘突出症的临床相关性研究[D].重庆:解放军陆军军医大学;第三军医大学,2017.
[3]刘玉成.腰椎管狭窄临床症状用影像检查验证的临床意义[J].中国医药指南,2017,15(30):82-83.
[4]Sun D,Liu P,Cheng J,et al.Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation.BMC Musculoskelet Disord.2017;18(1):167.
[5]Pathria M,Sartoris DJ,Resnick D.Osteoarthritis of the facet joints:accuracy of oblique radiographic assessment.Radiology.1987;164:227-230.
[6]Claren?on F,Lawye B,Bienvenot P,et al.The degenerative spine.Magn Reson Imaging Clin N Am.2016;24(3):495-513.
[7]曹勇.单排螺旋CT对腰椎间盘突出症并发椎管狭窄的诊断价值分析[J].中外医学研究,2016,14(18):42-43.
[8]张春,刘红梅.下腰椎小关节退行性病变的X线、CT、MRI影像学比较[J].包头医学院学报,2016,32(3):84-85.
[9]乔聚义.下腰椎小关节退变的磁共振成像及CT表现特征分析[J].实用医学影像杂志,2016,17(3):265-266.
[10]Weishaupt D,Zanetti M,Boos N,et al.MR imaging and CT in osteoarthritis of the lumbar facet joints.Skeletal Radiol.1999;28(4):215-219.
[11]Abbas J,Slon V,Stein D,et al.In the quest for degenerative lumbar spinal stenosis etiology:The Schmorl's nodes model.BMCMusculoskelet Disord.2017;18(1):164.
[12]Lurie J,Tomkinslane C.Management of lumbar spinal stenosis.BMJ.2016;352(1):6234.
[13]史少岩,黄研生,郝定均.腰椎管狭窄的治疗进展[J].中国骨伤,2017,30(5):484-488.
[14]Kalichman L,Li L,Kim DH,et al.Facet joint osteoarthritis and low back pain in the community-based population.Spine.2008;33(23):2560-2565.
[15]Yabuki S,Fukumori N,Takegami M,et al.Prevalence of lumbar spinal stenosis,using the diagnostic support tool,and correlated factors in Japan:a population-based study.J Orthop Sci.2013;18(6):893-900.
[16]殷刚,邱勇.腰椎小关节骨性关节炎危险因素的研究进展[J].中国矫形外科杂志,2009,17(13):995-997.
[17]Abbas J,Hamoud K,Peleg S,et al.Facet joints arthrosis in normal and stenotic lumbar spines.Spine.2011;36(24):1541-1546.
[18]郭增峰,于滨生.腰椎小关节骨性关节炎的研究进展[J].中国矫形外科杂志,2017,25(17):1587-1591.
[19]祝恺,谭军,张紫豪,等.腰椎小关节骨关节炎宏观及微观改变的研究进展[J].中国骨与关节杂志,2017,6(10):764-767.
[20]Simon P,Espinoza Orías AA,Andersson GB,et al.In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects.Spine.2012;37(12):1058-1064.
[21]Grobler LJ,Robertson PA,Novotny JE,et al.Etiology of spondylolisthesis.Assessment of the role played by lumbar facet joint morphology.Spine.1993;18(1):80-91.
[22]Jentzsch T,Geiger J,Zimmermann SM,et al.Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine.Radiol Res Pract.2013;2013:693971.
[23]Linov L,Klindukhov A,Li L,et al.Lumbar facet joint orientation and osteoarthritis:a cross-sectional study.J Back Musculoskelet Rehabil.2013;26(4):421-426.
[24]顾树明,张彦东,肖京,等.腰椎小关节方向和骨性关节炎分级与侧隐窝狭窄症的关系[J].中国医刊,2015,50(1):43-45.
[25]闫广辉,高春光,李华,等.腰椎小关节精确测量及其与腰椎管狭窄症的相关性研究[J].中国现代医学杂志,2015,25(35):88-91.
[26]黄宗文,黄创新,郭远清,等.下腰椎形态与椎管退行性狭窄的关系及其临床意义[J].中国脊柱脊髓杂志,2004,14(11):663-665.
[27]肖伟平,杨凤云.腰椎小关节矢状化与年龄、体重指数之间的相关性研究[C].//第二十四届全国中西医结合骨伤科学术年会论文集,2017:233-233.
[28]李志赏,闫广辉,张庆胜,等.年龄相关的腰椎小关节三维角度的变化规律[J].中国现代医学杂志,2016,26(20):78-81.
[29]覃柳生.腰椎关节突关节退变的影像学表现及意义[J].实用医学影像杂志,2014,15(5):357-359.
[30]Boden SD,Riew KD,Yamaguchi K,et al.Orientation of the lumbar facet joints:association with degenerative disc disease.J Bone Joint Surg Am.1996;78(3):403-411.
[31]程若勤,程小杰.腰椎小关节骨性关节炎与小关节角度及不对称性的关系[J].现代仪器与医疗,2013,19(2):28-31.
[32]闫广辉,徐宝山,夏群,等.腰椎小关节方向性与腰椎间盘突出症[J].中国组织工程研究,2011,15(35):6563-6566.
[33]荆慧田,冯世庆,班德翔.关节突关节角度与退行性腰椎滑脱的关系[J].中国脊柱脊髓杂志,2011,21(4):299-302.
[34]Fujiwara A,Tamai K,An HS,et al.Orientation and osteoarthritis of the lumbar facet joint.Clin Orthop Relat Res.2001;385(385):88-94.
[2]王洪岗.小关节方向不规则变化与腰椎间盘突出症的临床相关性研究[D].重庆:解放军陆军军医大学;第三军医大学,2017.
[3]刘玉成.腰椎管狭窄临床症状用影像检查验证的临床意义[J].中国医药指南,2017,15(30):82-83.
[4]Sun D,Liu P,Cheng J,et al.Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation.BMC Musculoskelet Disord.2017;18(1):167.
[5]Pathria M,Sartoris DJ,Resnick D.Osteoarthritis of the facet joints:accuracy of oblique radiographic assessment.Radiology.1987;164:227-230.
[6]Claren?on F,Lawye B,Bienvenot P,et al.The degenerative spine.Magn Reson Imaging Clin N Am.2016;24(3):495-513.
[7]曹勇.单排螺旋CT对腰椎间盘突出症并发椎管狭窄的诊断价值分析[J].中外医学研究,2016,14(18):42-43.
[8]张春,刘红梅.下腰椎小关节退行性病变的X线、CT、MRI影像学比较[J].包头医学院学报,2016,32(3):84-85.
[9]乔聚义.下腰椎小关节退变的磁共振成像及CT表现特征分析[J].实用医学影像杂志,2016,17(3):265-266.
[10]Weishaupt D,Zanetti M,Boos N,et al.MR imaging and CT in osteoarthritis of the lumbar facet joints.Skeletal Radiol.1999;28(4):215-219.
[11]Abbas J,Slon V,Stein D,et al.In the quest for degenerative lumbar spinal stenosis etiology:The Schmorl's nodes model.BMCMusculoskelet Disord.2017;18(1):164.
[12]Lurie J,Tomkinslane C.Management of lumbar spinal stenosis.BMJ.2016;352(1):6234.
[13]史少岩,黄研生,郝定均.腰椎管狭窄的治疗进展[J].中国骨伤,2017,30(5):484-488.
[14]Kalichman L,Li L,Kim DH,et al.Facet joint osteoarthritis and low back pain in the community-based population.Spine.2008;33(23):2560-2565.
[15]Yabuki S,Fukumori N,Takegami M,et al.Prevalence of lumbar spinal stenosis,using the diagnostic support tool,and correlated factors in Japan:a population-based study.J Orthop Sci.2013;18(6):893-900.
[16]殷刚,邱勇.腰椎小关节骨性关节炎危险因素的研究进展[J].中国矫形外科杂志,2009,17(13):995-997.
[17]Abbas J,Hamoud K,Peleg S,et al.Facet joints arthrosis in normal and stenotic lumbar spines.Spine.2011;36(24):1541-1546.
[18]郭增峰,于滨生.腰椎小关节骨性关节炎的研究进展[J].中国矫形外科杂志,2017,25(17):1587-1591.
[19]祝恺,谭军,张紫豪,等.腰椎小关节骨关节炎宏观及微观改变的研究进展[J].中国骨与关节杂志,2017,6(10):764-767.
[20]Simon P,Espinoza Orías AA,Andersson GB,et al.In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects.Spine.2012;37(12):1058-1064.
[21]Grobler LJ,Robertson PA,Novotny JE,et al.Etiology of spondylolisthesis.Assessment of the role played by lumbar facet joint morphology.Spine.1993;18(1):80-91.
[22]Jentzsch T,Geiger J,Zimmermann SM,et al.Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine.Radiol Res Pract.2013;2013:693971.
[23]Linov L,Klindukhov A,Li L,et al.Lumbar facet joint orientation and osteoarthritis:a cross-sectional study.J Back Musculoskelet Rehabil.2013;26(4):421-426.
[24]顾树明,张彦东,肖京,等.腰椎小关节方向和骨性关节炎分级与侧隐窝狭窄症的关系[J].中国医刊,2015,50(1):43-45.
[25]闫广辉,高春光,李华,等.腰椎小关节精确测量及其与腰椎管狭窄症的相关性研究[J].中国现代医学杂志,2015,25(35):88-91.
[26]黄宗文,黄创新,郭远清,等.下腰椎形态与椎管退行性狭窄的关系及其临床意义[J].中国脊柱脊髓杂志,2004,14(11):663-665.
[27]肖伟平,杨凤云.腰椎小关节矢状化与年龄、体重指数之间的相关性研究[C].//第二十四届全国中西医结合骨伤科学术年会论文集,2017:233-233.
[28]李志赏,闫广辉,张庆胜,等.年龄相关的腰椎小关节三维角度的变化规律[J].中国现代医学杂志,2016,26(20):78-81.
[29]覃柳生.腰椎关节突关节退变的影像学表现及意义[J].实用医学影像杂志,2014,15(5):357-359.
[30]Boden SD,Riew KD,Yamaguchi K,et al.Orientation of the lumbar facet joints:association with degenerative disc disease.J Bone Joint Surg Am.1996;78(3):403-411.
[31]程若勤,程小杰.腰椎小关节骨性关节炎与小关节角度及不对称性的关系[J].现代仪器与医疗,2013,19(2):28-31.
[32]闫广辉,徐宝山,夏群,等.腰椎小关节方向性与腰椎间盘突出症[J].中国组织工程研究,2011,15(35):6563-6566.
[33]荆慧田,冯世庆,班德翔.关节突关节角度与退行性腰椎滑脱的关系[J].中国脊柱脊髓杂志,2011,21(4):299-302.
[34]Fujiwara A,Tamai K,An HS,et al.Orientation and osteoarthritis of the lumbar facet joint.Clin Orthop Relat Res.2001;385(385):88-94.