CAJ | 학술논문

目的：探讨腰椎关节突关节形态学变化在退变性腰椎滑脱（degenerative lumbar spondylolisthesis，DLS）发生中的病因学意义。方法自2007年1月至2013年7月收治的L4，5 DLS患者中随机选取115例作为观察组，男28例，女87例；年龄41~76岁，平均57.3岁。自体检人群（无脊柱滑脱及腰腿痛表现）中随机选取与DLS组年龄、性别相匹配的115例作为对照组，男31例，女84例；年龄45~77岁，平均56.4岁。两组均行腰椎正、侧位X线片，CT平扫及多层面重建检查。于侧位X线片测量DLS组患者腰椎滑脱程度（Taillard指数），CT图像分别测量滑脱组及对照组L3，4、L4，5节段两侧关节突关节角并评估两组小关节不对称程度,矢状面CT重建图像测量两组L3，4、L4，5关节突关节椎弓根角（pedicle facet angle，P?F角），对两组相应节段所测角度进行比较分析；CT横断面骨窗下对两组L4，5关节突关节进行退变程度分级并比较，且对DLS组不同退变等级之间的滑脱程度进行分析。对DLS组L4，5的关节突关节角、P?F角与滑脱程度进行相关性分析。结果 DLS组L4,5均为Ⅰ度滑脱。DLS组L3，4、L4，5节段关节突关节角与对照组相应节段相比明显偏向矢状位；P?F角均较对照组大，更倾向于水平位。小关节不对称程度，L4，5节段DLS组与对照组比较差异有统计学意义，而L3,4节段的差异无统计学意义。两组L4，5关节突关节退变程度比较差异有统计学意义，DLS组患者L4，5关节突关节不同退变等级之间，滑脱程度的差异无统计学意义。DLS组L4，5滑脱程度与其关节突关节角、P?F角无相关性。结论关节突关节形态学变化（更小的关节突关节角、水平化的P?F角、小关节不对称）对退变性腰椎滑脱的发生具有一定的病因学意义，但其作用不应被夸大；关节突关节退变是随着年龄增长出现的继发性改变，而腰椎滑脱加剧了小关节的退变。目的：探討腰椎關節突關節形態學變化在退變性腰椎滑脫（degenerative lumbar spondylolisthesis，DLS）髮生中的病因學意義。方法自2007年1月至2013年7月收治的L4，5 DLS患者中隨機選取115例作為觀察組，男28例，女87例；年齡41~76歲，平均57.3歲。自體檢人群（無脊柱滑脫及腰腿痛錶現）中隨機選取與DLS組年齡、性彆相匹配的115例作為對照組，男31例，女84例；年齡45~77歲，平均56.4歲。兩組均行腰椎正、側位X線片，CT平掃及多層麵重建檢查。于側位X線片測量DLS組患者腰椎滑脫程度（Taillard指數），CT圖像分彆測量滑脫組及對照組L3，4、L4，5節段兩側關節突關節角併評估兩組小關節不對稱程度,矢狀麵CT重建圖像測量兩組L3，4、L4，5關節突關節椎弓根角（pedicle facet angle，P?F角），對兩組相應節段所測角度進行比較分析；CT橫斷麵骨窗下對兩組L4，5關節突關節進行退變程度分級併比較，且對DLS組不同退變等級之間的滑脫程度進行分析。對DLS組L4，5的關節突關節角、P?F角與滑脫程度進行相關性分析。結果 DLS組L4,5均為Ⅰ度滑脫。DLS組L3，4、L4，5節段關節突關節角與對照組相應節段相比明顯偏嚮矢狀位；P?F角均較對照組大，更傾嚮于水平位。小關節不對稱程度，L4，5節段DLS組與對照組比較差異有統計學意義，而L3,4節段的差異無統計學意義。兩組L4，5關節突關節退變程度比較差異有統計學意義，DLS組患者L4，5關節突關節不同退變等級之間，滑脫程度的差異無統計學意義。DLS組L4，5滑脫程度與其關節突關節角、P?F角無相關性。結論關節突關節形態學變化（更小的關節突關節角、水平化的P?F角、小關節不對稱）對退變性腰椎滑脫的髮生具有一定的病因學意義，但其作用不應被誇大；關節突關節退變是隨著年齡增長齣現的繼髮性改變，而腰椎滑脫加劇瞭小關節的退變。
목적：탐토요추관절돌관절형태학변화재퇴변성요추활탈（degenerative lumbar spondylolisthesis，DLS）발생중적병인학의의。방법자2007년1월지2013년7월수치적L4，5 DLS환자중수궤선취115례작위관찰조，남28례，녀87례；년령41~76세，평균57.3세。자체검인군（무척주활탈급요퇴통표현）중수궤선취여DLS조년령、성별상필배적115례작위대조조，남31례，녀84례；년령45~77세，평균56.4세。량조균행요추정、측위X선편，CT평소급다층면중건검사。우측위X선편측량DLS조환자요추활탈정도（Taillard지수），CT도상분별측량활탈조급대조조L3，4、L4，5절단량측관절돌관절각병평고량조소관절불대칭정도,시상면CT중건도상측량량조L3，4、L4，5관절돌관절추궁근각（pedicle facet angle，P?F각），대량조상응절단소측각도진행비교분석；CT횡단면골창하대량조L4，5관절돌관절진행퇴변정도분급병비교，차대DLS조불동퇴변등급지간적활탈정도진행분석。대DLS조L4，5적관절돌관절각、P?F각여활탈정도진행상관성분석。결과 DLS조L4,5균위Ⅰ도활탈。DLS조L3，4、L4，5절단관절돌관절각여대조조상응절단상비명현편향시상위；P?F각균교대조조대，경경향우수평위。소관절불대칭정도，L4，5절단DLS조여대조조비교차이유통계학의의，이L3,4절단적차이무통계학의의。량조L4，5관절돌관절퇴변정도비교차이유통계학의의，DLS조환자L4，5관절돌관절불동퇴변등급지간，활탈정도적차이무통계학의의。DLS조L4，5활탈정도여기관절돌관절각、P?F각무상관성。결론관절돌관절형태학변화（경소적관절돌관절각、수평화적P?F각、소관절불대칭）대퇴변성요추활탈적발생구유일정적병인학의의，단기작용불응피과대；관절돌관절퇴변시수착년령증장출현적계발성개변，이요추활탈가극료소관절적퇴변。
Objective To investigate the etiologic effect of the lumbar facet joint morphology on the occurrence of degener?ative lumbar spondylolisthesis (DLS). Methods From January 2007 to July 2013, 115 patients with DLS treated in our hospi?tal were randomly selected. There were 28 males and 87 females with an average age of 57.3 years (range, 41-76 years). 115 age? and sex? matched people including 31 males and 84 females with an average age of 56.4 years (range, 45-77 years) free from DLS and back or leg pain were selected randomly as control group from a group coming for routine physical examination in our hospital. Both groups received lumbar anteroposterior and lateral X?ray films、CT scanning and multiplanar reformation, the degree of spondylolisthesis (Taillard index) was measured in DLS group on lateral radiographs; at L3,4 and L4,5 level of both groups the facet joint angles on CT scan images were measured and facet tropism was evaluated, the pedicle?facet angle (the P?F angle) was measured in the sagittal plane on multiplanar reformation CT images, and then all angles of corresponding level were compared and analyzed; L4,5 facet joint degeneration in both groups was evaluated and compared in bone window, the de?gree of spondylolisthesis (Taillard index) in DLS group at different degenerative grade of facet joints were analyzed. The corre?lation between L4,5 facet joint angle、P?F angle and degrees of spondylolisthesis were analyzed. Results All L4,5 spondylolisthe?sis in DLS group were grade I, the facet joint angles were more sagittal in DLS group than those in the control group at L 3,4 and L4,5 levels, and the P?F angles were more horizontal in DLS group compared with control group;the facet tropism in DLS group at L 4,5 level were significantly different as compared to the control group, but there was no significant difference at L 3,4 level between the two groups. Significant difference was found in L4,5 facet joint degeneration grade between two groups,but there was no significant difference in degree of spondylolisthesis during different degeneration grades in DLS group. There was no significant correlation between the facet joint angle and the P?F angle and degree of spondylolisthesis at L4,5 level in DLS group. Conclusion The facet joint morphology abnormality (smaller facet joint angle, horizontal P?F angle, the facet tropism) has an important etiologic meaning in the occurrence of degenerative lumbar spondylolisthesis, however its role cannot be excessively exaggerated. The facet joint de?generation is a secondary change with aging,while the development of DLS aggravates the degeneration.