CAJ | 학술논문

目的通过撑开腰椎棘突,观察其撑开程度与对应的椎间孔形态变化及小关节位移之间的关系.方法使用6具新鲜腰椎尸体,制作标本,保留关节突周围关节囊韧带及棘间韧带,通过分别撑开L3-4,L4-5棘突,测量相应节段小关节间相对位移、椎间孔高度及宽度改变.结果腰椎退变表现为小关节增生,移位,椎间孔形态发生变形,神经根不同程度受到压迫,椎间隙不同程度狭窄等表现.棘突间撑开2 mm,L3-4、L4-5腰椎间孔高度[(15.62 ±0.73)mm、(14.67 ±0.75)mm]较原始状态[(13.89 ±0.77) mm、(12.48 ±0.80)mm]明显增大(t=26.00、16.02,P＜0.01);棘突间撑开4mm,L3-4、L4-5腰椎间孔高度[(17.13 ±0.78)mm、(16.74 ±0.76) mm]较原始状态均明显增大(t=36.15、30.69,P＜0.01);撑开4 mm椎间孔高度较撑开2 mm有明显增大(t=20.82、21.72,P＜0.01);棘突间撑开2 mm,L3-4、L4-5小关节位移[(0.31±0.04) mm、(0.34 ±0.07) mm]较原始状态[(0.63 ±0.03)mm、(0.56 ±0.05)mm]改善,差异均有统计学意义(t=61.97、58.91,P＜0.01);棘突间撑开4 mm,L3-4、L4-5小关节位移[(0.10±0.04)mm、(0.12 ±0.06) mm]较原始状态均改善,差异均有统计学意义(t =64.92、65.25,P＜0.01);较撑开2 mm差异也有统计学意义(t=18.69、18.88,P＜0.01);撑开2 mm椎间孔宽度[(8.65 ±0.38)mm、(7.78 ±0.37) mm]与原始状态比较差异无统计学意义(P＞0.05),在4 mm宽度[(9.03 ±0.41)mm、(8.05 ±0.32) mm]增大差异有统计学意义(t =7.78、7.97,P＜0.01).结论棘突撑开能有效改善小关节位移、增加椎间孔高度,但对于椎间孔宽度的增加需要撑开足够距离.
목적 통과탱개요추극돌,관찰기탱개정도여대응적추간공형태변화급소관절위이지간적관계.방법 사용6구신선요추시체,제작표본,보류관절돌주위관절낭인대급극간인대,통과분별탱개L3-4,L4-5극돌,측량상응절단소관절간상대위이、추간공고도급관도개변.결과 요추퇴변표현위소관절증생,이위,추간공형태발생변형,신경근불동정도수도압박,추간극불동정도협착등표현.극돌간탱개2 mm,L3-4、L4-5요추간공고도[(15.62 ±0.73)mm、(14.67 ±0.75)mm]교원시상태[(13.89 ±0.77) mm、(12.48 ±0.80)mm]명현증대(t=26.00、16.02,P＜0.01);극돌간탱개4mm,L3-4、L4-5요추간공고도[(17.13 ±0.78)mm、(16.74 ±0.76) mm]교원시상태균명현증대(t=36.15、30.69,P＜0.01);탱개4 mm추간공고도교탱개2 mm유명현증대(t=20.82、21.72,P＜0.01);극돌간탱개2 mm,L3-4、L4-5소관절위이[(0.31±0.04) mm、(0.34 ±0.07) mm]교원시상태[(0.63 ±0.03)mm、(0.56 ±0.05)mm]개선,차이균유통계학의의(t=61.97、58.91,P＜0.01);극돌간탱개4 mm,L3-4、L4-5소관절위이[(0.10±0.04)mm、(0.12 ±0.06) mm]교원시상태균개선,차이균유통계학의의(t =64.92、65.25,P＜0.01);교탱개2 mm차이야유통계학의의(t=18.69、18.88,P＜0.01);탱개2 mm추간공관도[(8.65 ±0.38)mm、(7.78 ±0.37) mm]여원시상태비교차이무통계학의의(P＞0.05),재4 mm관도[(9.03 ±0.41)mm、(8.05 ±0.32) mm]증대차이유통계학의의(t =7.78、7.97,P＜0.01).결론 극돌탱개능유효개선소관절위이、증가추간공고도,단대우추간공관도적증가수요탱개족구거리.
Objective To investigate the relationship among the spinous process open degree,the relative displacement of the lumbar facet joints(LFJ),and the morphologic change of the intervertebral foramina.Methods From Nov 2010 to Jun 2012,a total of 6 human fresh cadaveric spines was used in this study.All the ligaments were kept.The relative displacement of the corresponding segments LFJ,and the change of height and width of intervertebral foramen were measured through the corresponding open L3-4 and L4-5 spinous process,respectively.Results Lumbar degeneration was described with the following indices including the proliferation and displacement of LFJ,deformation of the intervertebral foramen morphogenesis,nerve root oppression,and lumbar intervertebral stenosis.When the interspinous process spacer was opened up to 2 mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(15.62 ± 0.73) mm,(14.67 ± 0.75) mm] were significantly increased (t =26.00,16.02,P ＜ 0.01) compared to the original state [(13.89 ± 0.77) mm,(12.48 ± 0.80)mm].When the interspinous process spacer was opened up to 4mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(17.13 ± 0.78) mm,(16.74 ± 0.76) mm] were significantly increased (t =36.15,30.69,P ＜ 0.01) compared to the original state.The foraminal height with a 4 mm distraction was significantly greater than the 2 mm distraction (t =20.82,21.72,P ＜0.01).When the interspinous distraction was 2 mm,L FJ displacement at the L3-4and L4-5 [(0.31 ±0.04) mm,(0.34 ± 0.07) mm] was significantly better than the original state [(0.63 ± 0.03) mm,(0.56±0.05)mm] (t =61.97,58.91,P ＜0.01).When the interspinous distraction was 4 mm,LFJ displacement at the L3-4 and L4-5 [(0.10 ±0.04) mm,(0.12 ±0.06) mm] was significantly better than the original state (t =18.69,18.88,P ＜0.01).No significant difference was found in the change of the intervertebral foramen width [(8.65 ± 0.38) mm,(7.78 ± 0.37) mm] at the 2 mm interspinous distraction compared to the original state(P ＞ 0.05),but a statistically significant difference was found at the 4 mm interspinous distraction compared to the original state [(9.03 ± 0.41) mm,(8.05 ± 0.32) mm] (t =7.78,7.97,P ＜ 0.01).Conclusions Spinous process shove off can effectively improve LFJ displacement,and increase the intervertebral foramen height,but the increase of its width needs to shove off enough distance.