退变性腰椎滑脱发病的相关因素探讨

[目的]探讨退变性腰椎滑脱发生的相关因素。[方法] 2016年6月～2018年5月,198例腰腿疼痛患者纳入本研究。其中,退变滑脱组95例,无滑脱组103例。测量两组患者的BMI、骨盆入射角、骨盆倾斜体、骶骨倾斜角、腰骶角、腰椎前凸角;采用Kalichman关节突退变分级和Pfirrmann椎间盘退变分级评价退变程度。[结果]两组的体质量指数、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰骶角、腰椎前凸角差异无统计学意义(P0.05)。退变滑脱组的骨盆入射角明显大于无滑脱组,差异有统计学意义(P0.05);退变滑脱组的L_(4/5)节段关节突关节角明显大于无滑脱组,差异有统计学意义(P0.05)。滑脱节段Kalichman关节突关节退变程度分级和Pfirrmann椎间盘退变分级均显著大于非滑脱节段(P0.05);Kalichman分级和Pfirrmann分组呈显著正相关(P0.05)。[结论]退变性腰椎滑脱的关节突关节和椎间盘退变程度重,骨盆入射角较大,L_(4/5)关节突关节的方向更趋向矢状位。     

关节突关节角变化与退变性腰椎滑脱间关系的研究

目的探讨关节突关节角的改变与退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)发生之间的因果关系。方法回顾性选取2011-07-2014-07我科收治的50例L4-5单节段退变性前滑脱患者作为DLS组,另选同期50例无腰腿痛和脊椎滑脱的正常患者作为对照组,且使性别、年龄与DLS组相匹配。两组均行站立位腰椎正侧位X线片及腰椎三维CT检查,在腰椎侧位X线上测量腰椎滑脱指数;在CT矢状位图像上选取平行于L3-4、L4-5、L5-S1椎间隙上缘终板的CT横断位图像作为关节突的头侧部分;过椎弓根下缘且平行于L3-4、L4-5、L5-S1椎间隙下缘终板的CT横断图像作为关节突的尾侧部分,在横断位上进行关节突角度测量,同时在骨窗下对关节突的退变进行评估。结果 DLS组L3-4头侧关节突关节角(61.9±6.3)°大于对照组的(56.3±7.5)°,尾侧关节突关节角(57.1±6.9)°大于对照组的(51.9±6.8)°;DLS组L4-5头侧关节突关节角(55.8±5.6)°大于对照组的(50.2±6.7)°,尾侧关节突关节角(53.2±6.8)°大于对照组的(47.0±5.9)°;DLS组L5-S1头侧关节突关节角(49.1±7.8)°大于对照组的(43.9±6.9)°,尾侧关节突关节角(45.1±6.9)°大于对照组的(41.7±5.1)°,差异均具有显著性(P0.05)。DLS组患者L4-5头尾侧角度差值(2.1±0.8)°小于对照组的(5.0±1.3)°,差异具有显著性(P0.05)。DLS组L4-5左右两侧关节突关节角不对称度(8.0±2.0)°大于对照组的(4.2±1.3)°,差异有显著性(P0.05)。按关节突关节退变等级将DLS患者分成3组,各组间滑脱指数差异具有显著性(P0.05),不同退变等级中头、尾侧关节突关节角度差异具有显著性(r=0.457,P0.05)。结论关节突关节矢状化改变更可能是腰椎退变性滑脱发生预先存在的解剖学因素。     

退变性腰椎滑脱的关节突关节形态学分析

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。     

L_4退变性滑脱症椎间盘真空征的临床意义

[目的]探讨退变性腰椎滑脱症椎间盘真空现象对腰椎骨盆矢状面形态和手术疗效的影响。[方法]回顾性分析2009年1月~2014年3月行TLIF手术治疗且有2年以上随访的125例Ⅰ~Ⅱ度退变性L_4椎滑脱症患者,其中男44例、女111例;年龄41~70岁(平均54.7岁)。根据在CT上是否伴有椎间盘真空现象将患者分为真空现象组和非真空现象组。于术前、术后和中期随访时,测量滑脱参数:滑脱率、滑脱角、椎间隙高度、局部后凸角;腰椎骨盆参数:骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角和L_1椎体中心至骶骨垂线间距离。采用t检验比较两组间影像学的差异。[结果]本组伴椎间盘真空现象13例(10.4%)。真空现象组患者平均年龄显著高于非真空现象组[(60.7±13.6)岁∶(54.4±11.9)岁,P<0.05)]。术前真空现象组和非真空现象组滑脱率分别为(24.3±3.9)和(20.7±4.6)%,滑脱角分别为(2.7±2.1)°和(7.4±3.3)°,局部后凸角分别为(-1.4±2.3)°和(-8.2±4.7)°,椎间隙高度分别为(0.17±0.09)mm和(0.27±0.10)mm,两组比较差异均有统计学意义(P<0.05);术前真空现象组PT和LASD明显高于非后凸型滑脱组(P>0.05),而SS和LL明显小于非后凸型滑脱组(P<0.05),两组患者PI差异无统计学意义(P>0.05)。经TLIF手术后,两组患者术后及末次随访时各影像学指标较术前均明显改善。但至术后和末次随访时非真空现象组滑脱率、滑脱角和椎间隙高度改善均显著优于真空现象组(P<0.05);术后及末次随访时两组患者PI、PT、SS和LASD差异无统计学意义(P>0.05),但真空现象组LL显著小于非真空现象组。[结论]伴有椎间盘真空现象的L_4退变性滑脱患者椎间隙显著塌陷,是滑脱椎体复位不佳的预测指标。     

退变性腰椎侧凸脊柱-骨盆矢状位影像学特点

目的 :观察退变性腰椎侧凸(DLS)患者脊柱-骨盆矢状位影像学特点,探讨脊柱-骨盆矢状位参数变化对DLS发生的影响。方法:回顾性分析103例DLS患者术前资料,男36例,女67例,年龄62.6±7.4(43~78)岁,并选取139例正常青年人群作为正常青年对照组,145例单纯颈椎病患者作为成年对照组,在脊柱全长正侧位X线片上测量各组冠状位、矢状位参数,包括L3倾斜角、侧凸Cobb角、冠状位平衡(CVA)、腰椎前凸角(LL)、矢状位平衡(SVA)、胸椎后凸角(TK)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)等,采用独立样本t检验比较DLS组与两对照组的各矢状位参数,并用Pearson相关分析DLS组各参数间相关性。结果:DLS组PI为50.4°±10.2°,显著高于正常青年对照组(45.1°±9.6°,P0.01)和成年对照组(46.9°±9.1°,P0.01)。与青年及成年对照组相比,DLS组LL、SS较小(P0.01),PT、SVA较大(P0.01);TK小于成年对照组(P0.01)。DLS组中合并退变性腰椎滑脱者37例(占35.9%),PI为53.1°±8.8°;无退变性腰椎滑脱者66例,PI为48.9°±10.6°,二者相比有统计学差异且均显著高于正常青年对照组(P0.05)。DLS组侧凸Cobb角与PT显著相关(P0.05),余冠状位参数与矢状位参数间未发现相关性;LL、PI、SS、PT两两之间显著相关(P0.01),LL、PT与TK显著相关(P0.01),SS与TK显著相关(P0.05),LL与SVA显著相关(P0.01)。结论 :DLS患者PI高于正常青年及颈椎病患者,高PI可能参与了DLS的发病机制;DLS患者退变、侧凸的腰椎仍存在调节矢状位平衡的能力。     

青少年L5S1发育性滑脱与峡部裂性滑脱的脊柱骨盆矢状面形态比较

目的:比较青少年L_5S_1发育不良性滑脱与峡部裂性滑脱的脊柱骨盆矢状面形态特点。方法:对2002年5月至2016年12月收治的24例影像资料完整的青少年L_5S_1滑脱患者的病例资料进行回顾性分析。男8例,女16例,年龄10～18(13.4±2.0)岁;其中发育不良性滑脱(发育不良组)9例,峡部裂性滑脱(峡部裂组)15例。在站立位脊柱侧位片上测量滑脱相关指标(滑移距离、滑脱率、滑脱角)和脊柱骨盆矢状面形态指标(矢状面偏移、胸椎后凸角、腰椎前凸角、L_5入射角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、骨盆矢状面厚度、腰骶角、骶骨平台角)。对两组影像学参数进行统计学分析。结果:两组患者的滑脱距离、滑脱率和滑脱角差异无统计学意义。发育性滑脱组矢状面偏移、L_5入射角、骨盆倾斜角和骨盆矢状面厚度均明显高于峡部裂性滑脱组(P0.05)。发育性滑脱组的骶骨倾斜角、腰骶角和骶骨平台角则显著低于峡部裂性滑脱组(P0.05)。两组间胸椎后凸角和腰椎前凸角差异无统计学意义(P0.05)。结论:与峡部裂性滑脱明显不同,发育不良性滑脱表现为躯干前倾明显,骨盆后倾。对于发育不良性滑脱,需要严密观察,出现矢状面失平衡时则应早期手术干预。     

关节突关节角度与退行性腰椎滑脱的关系

目的:探讨关节突关节角度与退行性腰椎滑脱(DLS)的关系。方法:选取2008年7月～2010年6月我院收治的60例单纯退行性L4/5节段前滑脱患者为DLS组,年龄55.6±8.8岁,排除腰椎骨折及峡部不连者;对照组为57例同期无滑脱及腰腿痛的其他疾病患者,年龄53.7±9.4岁。两组均行腰椎CT检查,在CT定位像上测量DLS组患者L4/5节段滑移距离及下位椎体矢状径,计算腰椎滑脱程度(Taillard指数);在CT图像上测量两组L3/4、L4/5及L5/S1节段关节突关节角并进行比较分析;骨窗条件下观察DLS组L4/5关节突关节退变程度,按Fujiwara标准进行分级,并按不同退变等级分3组比较滑脱程度;对DLS组L4/5的关节突关节角与滑脱程度进行直线相关性分析。结果:DLS组L4/5均为Ⅰ度滑脱,Taillard指数为0.1679±0.0365。DLS组L4/5关节突关节角为33.1°±12.2°,小于对照组的49.5°±11.4°,差异有显著性(P<0.001);DLS组与对照组L3/4关节突关节角分别为36.1°±9.1°与38.6°±8.0°,无显著性差异(P>0.05);DLS组与对照组L5/S1关节突关节角分别为48.5°±13.0°与51.9°±13.0°,无显著性差异(P>0.05)。DLS组L4/5滑脱Taillard指数与其关节突关节角度无相关性(r=0.065,P>0.05)。DLS组患者L4/5关节突关节退变程度为Ⅱ度4例,Ⅲ度23例,Ⅳ度33例,其滑脱Taillard指数分别为0.1837±0.0418、0.1723±0.0370和0.1589±0.0343,各组间滑脱程度差异无显著性(P>0.05)。结论:DLS患者滑脱节段的关节突关节角明显小于非滑脱患者的相应节段,但关节突关节角度与DLS的关系尚不明确。     

脊柱骨盆矢状位参数预测退变性腰椎滑脱发生及发展的危险因素

目的探讨脊柱骨盆矢状位参数预测退变性腰椎滑脱发生及发展的危险因素。方法退变性腰椎滑脱及退变性腰椎管狭窄症病人71例,其中退变性腰椎滑脱病人36例,退变性腰椎管狭窄症病人35例。在站立位全脊柱侧位片上测量骨盆投射角(PI)、骶骨倾斜角(SS)、骨盆倾斜度(PT)、腰椎前凸角(LL)、胸椎后凸角(TK)、腰椎骨盆前凸角(PR-LI,PR-L2,PR-L3,PR-L4,PR-L5)、骨盆形态(PR-S1)、腰4椎体倾斜角(L4S)、腰5椎体倾斜角(L5S)。所测退变性腰椎滑脱病例脊柱骨盆参数分别与退变性腰椎管狭窄症及正常国人脊柱骨盆参数进行比较,采用两独立样本t检验比较两组参数间的差异。结果退变性腰椎滑脱组PI[(57.67±11.78)°]、SS[(37.83±9.17)°]、LL[(54.65±11.45)°]明显大于退变性腰椎管狭窄症组[(44.47±8.75)°,(28.18±9.02)°,(38.97±15.59)°]及正常参考值[(44.75±9.01)°,(33.57±7.64)°,(48.75±10.03)°](P0.05);退变性腰椎滑脱组L4S[(8.18±9.98)°]、L5S[(19.96±8.33)°]明显大于退变性腰椎管狭窄症组[(3.32±7.95)°,(10.87±8.02)°](P0.05);退变性腰椎滑脱PR-L4[(57.63±13.44)°]、PR-L5[(45.76±10.92)°]及PR-S1[(27.91±10.41)°]明显小于退变性腰椎管狭窄症组[(65.48±10.70)°,(56.33±9.15)°,(38.63±7.29)°](P0.05)。结论高PI可能引起退变性腰椎滑脱发生及发展,L5椎体倾斜角是退变性腰椎滑脱发生的预测因素之一,退变性腰椎滑脱下腰椎骨盆前凸明显小于退变性腰椎管狭窄症。     

老年退变性腰椎滑脱症患者脊柱骨盆矢状面参数研究

目的分析比较≥65岁老年退变性腰椎滑脱症（degenerative lumbar spondylolisthesis,DLS）患者与同年龄段无滑脱人群的脊柱骨盆矢状面参数。方法选择2004年1月~2014年1月间于本院就诊,影像学资料完整,无峡部裂、椎体肿瘤,椎体结核、椎体压缩性骨折等疾病,且无腰椎手术史的≥65岁的DLS患者50例为滑脱组。以相同纳入标准选择50例年龄性别匹配的无腰椎滑脱的老年人为对照组。测量滑脱组患者腰椎滑脱椎间盘角和滑脱率均值,再测量并比较2组患者的腰椎前凸角（lumbar lordosis,LL）、骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）和骶骨倾斜角（sacral slope,SS）。滑脱组内再按性别分组比较各参数,并分别计算2组患者各参数间的相关性。结果滑脱组患者滑脱椎间盘角为7.4°±5.2°,滑脱率为（22.5±9.5）%。滑脱组患者的LL、PI、PT、SS均明显高于对照组。滑脱组内分性别比较时,滑脱参数和腰椎矢状面参数差异均无统计学意义。结论老年DLS患者较同龄无腰椎滑脱人群有着更大的LL、PI、PT、SS。性别因素可能对老年DLS患者的滑脱参数和主要脊柱骨盆矢状面参数无显著影响。     

退变性腰椎滑脱患者L4, 5关节突关节的形态学特点

目的基于Roussouly分型观察不同脊柱骨盆类型的退变性腰椎滑脱(degenerative lumbar spondylolisthesis, DLS)患者L4, 5关节突关节的形态学特点。方法回顾性分析2018年8月至2022年5月于西南医科大学附属医院骨科就诊的142例DLS患者资料, 男33例, 年龄(65.0±10.7)岁;女109例, 年龄(61.8±9.6)岁。在CT图像上测量L4, 5关节突关节的形态学参数:关节突关节角(facet joint angle, FJA)、椎弓根-关节突关节角(pedicle facet angle, PFA)、关节突关节的不对称性(facet joint tropism, FT)和关节突关节的骨关节炎(osteoarthritis, OA)程度;在术前站立中立位腰椎侧位X线片上测量骶骨倾斜角(sacral slope, SS)、腰椎前凸角(lumbar lordosis, LL)、L4椎体滑移程度(percentage of slip distance, SDP)。根据Roussouly分型将患者分为四组(Ⅰ、Ⅱ、Ⅲ和Ⅳ型), 比较各组间...     

脊柱－骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响

目的：探讨脊柱-骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响及相关性研究。方法：以2016年7月至2019年9月确诊的120例L₄-L₅单节段退变性滑脱患者为观察对象（滑脱组）,以性别和年龄相匹配的120例L₄-L₅节段退变性椎管狭窄患者为对照（对照组）。通过影像学资料测量如下参数：骨盆入射角（pelvic incidence,PI）,骨盆倾斜角（pelvic tilt,PT）,骶骨倾斜角（sacral slope,SS）,腰椎前凸（lumbar lordosis,LL）,胸椎后凸（thoracic kyphosis,TK）,矢状面平衡（sagittal vertical axis,SVA）,L₄-L₅头侧关节突关节角,尾侧关节突关节角及小关节不对称性。比较两组患者参数的差异并对有意义参数行Logistic回归分析。对退变性腰椎滑脱患者关节突关节方向与脊柱-骨盆参数进行相关性分析。结果：两组患者在PI、PT、LL、SVA、头侧关节突关节角、尾侧关节突关节角差异有统计学意义（P<0.05）;Logistic回归分析发现PI、PT及头侧关节突关节角是腰椎滑脱程度的危险因素（P<0.05）。滑脱组头侧关节突关节矢状化与PI、PT呈现显著相关（P<0.05）。结论：高PI、PT及头侧关节突关节矢状化是腰椎滑脱的危险因素,并且关节突关节矢状化程度和大PI、PT密切相关。     

退行性腰椎不稳发病相关因素的临床研究

目的分析性别、年龄、相应节段椎间盘退变、小关节突骨关节炎以及椎体滑脱与退行性腰椎不稳的相关性。方法行腰椎MRI及站立位过伸过屈侧位片检查,观察L1-S15个运动节段的椎间盘退变、椎间小关节退变以及有无椎体滑脱。腰椎不稳分为前水平位移不稳．后水平位移不稳和角度不稳。椎间盘退变分四度。小关节突退变分为4级。腰椎滑脱分四度。将结果进行Spearman等级相关分析。结果前向水平不稳与椎间盘退变呈正相关,与椎间小关节骨关节炎呈负相关,与椎体滑脱呈正相关;后向水平不稳与年龄呈正相关,与椎间盘退变呈正相关。与椎间小关节骨关节炎呈正相关,与椎体滑脱没有明显相关性。结论退行性腰椎不稳与多种因素具有显著相关性,但腰椎滑脱不一定有不稳。     

Three-dimensional digital measurement of the facet joint in normal individual and lumbar intervertebral disc herniation patients aged 13 – 18 years

BackgroundLumbar facet joint is an important element of spinal “three-joint complex”. Whether there is a relationship between strange structure of facet joint and adolescent lumbar disc herniation (ALDH) is nonetheless controversial, and the current research is mainly centered on adults.ObjectiveTo find out the normal lumbar facet joints between 13 and 18 years old to provide anatomical basis for early diagnosis and therapy of lumbar disc herniation.MethodsCT imaging information of 32 sufferers with lumbar disc herniation aged from 13 to 18 years old in Inner Mongolia have been collected as the ALDH group, and 62 wholesome subjects in the equal period had been chosen as the normal group. Uncooked records of continuous scanning lumbar tomography pix were imported into MIMICS 21.0 for evaluation and size in DICOM format. The parameters include facet joint height, facet joint width, et al.Results1. The left and right transverse angle of L₅S₁ segment in the ALDH group were (52.41 ± 9.2) ° and (55.99 ± 10.91) ° (P < 0.05), and the differences were statistically significant. The right side is larger than the left side. 2. Facet joint thickness in L₃-L₅ segment of the normal group was significantly higher than that of male (1.63 ± 0.32) mm than that of female (1.38 ± 0.25) mm; In 16–18 years old group, comparison of facet joint cross-sectional area was statistically significant (22.1 ± 3.04) mm² in male than (18.92 ± 3.71) mm² in female. 3. In comparison between normal and ALDH group, there was significant difference in L_3-4 transverse angle (P < 0.05), L_4-5 facet joint height and facet joint thickness (P < 0.05), L₅S₁ facet joint thickness and transverse angle (P < 0.05).ConclusionWhen ALDH occurs in the L₅S₁ segment, there is a substantial difference between the left and right sides of the transverse angle, and there is a difference in the thickness and the facet joint cross-sectional area between males and females, which is generally larger in males than in females. Facet joint height is larger, transverse angle of left and right is asymmetric, inferior articular process is larger, and facet joint thickness is smaller can indicate that lumbar disc herniation is effortless to occur.     

Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis

The orientation and tropism of the lumbar facet joints at L4-5 level was assessed by magnetic resonance imaging (MRI) in 53 patients with degenerative L4-5 spondylolisthesis and 53 age- and sex-matched normal control subjects. The degree of disc degeneration at the L4-5 level and of vertebral slip on lateral radiographs was also evaluated. Patients with degenerative spondylolisthesis had more sagittally orientated facet joints (P < 0.01) and more significant facet joint tropism (P < 0.05) than normal control subjects. For patients with degenerative spondylolisthesis, the facet joint tropism was significantly correlated with the degree of disc degeneration (P < 0.05). The results suggest that morphological abnormalities of the lumbar facet joints are a predisposing factor in the development of degenerative spondylolisthesis.     

The biomechanical influence of facet joint parameters on corresponding segment in the lumbar spine: a new visualization method

BACKGROUND CONTEXTFacet joints have been discussed as influential factors in the development of lumbar degeneration, which includes disc herniation and degenerative lumbar spondylolisthesis. Facet orientation (FO) and facet tropism (FT) are two important structural parameters of the lumbar facet joints. Many previous studies have focused on single parameter analysis of the lumbar spine. Owing to the correlation between independent variables, single-factor analysis cannot reflect the interaction between variables; however, there has been no corresponding biomechanical method developed to address this problem.PURPOSETo investigate the complex biomechanical influences on the lumbar spine when vertebral FO and FT are varied using finite element analysis (FEA) and contour maps visualization, and analyze the biomechanical role of facet joint structural parameters in the process of lumbar degenerative diseases.STUDY DESIGNA biomechanical modelling, analysis, and verification study was performed.METHODS: A three-dimensional non-linear FEA model of 3 denucleated intervertebral discs (L2-3, L3-4, L4-5) with adjacent vertebral bodies (L2-L5) was created. Previously performed in vitro experiments provided experimental data for the range of motion in each load direction that was used for calibration. For 12 lumbar models, different facet joint angles relative to the sagittal plane at both L3-4 facet joints were simulated for 35°≤FO≤50° and 0°≤FT≤15°. By modifying different values of FO and FT, FEA simulation of different lumbar spine models was performed. Contour maps were used to visualize the FO- and FT-relevant data.RESULTSUnder flexion, extension, and torsion moments, facet joint contact force and intradiscal stress increased with increasing FT. In the condition where FT remained 0° and increasing FO values, facet joint contact force and intradiscal stress remained low with no apparent increasing or decreasing trend when the model was under flexion, extension, and torsion moments. In the condition where FO and the FT values were varied at the same time, the highest force and stress regions in the contour maps were observed when all three types of moments were applied. Stress distributions of the L3-4 disc with different FT and FO values showed disc stress increased significantly with increases of FT and was concentrated on the ipsilateral region of the facet joint with the more sagittal orientation.CONCLUSIONSThe combination of FO and FT has an important impact on the corresponding disc and facet joints, but FT played a more significant role. Moreover, disc stress was concentrated on the ipsilateral region of facet joint with greater sagittal orientation when FT existed. FT with high sagittal orientation may increase risk of recurrent LDH due to increase ipsilateral disc pressure.CLINICAL SIGNIFICANCEThese biomechanical findings may help clinicians to understand the prognosis of some lumbar degenerative conditions.     

Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis: pilot study

The objective is to evaluate the geometric parameters of vertebral bodies and intervertebral discs in spinal segments adjacent to spondylolysis and spondylolisthesis. This pilot cross-sectional study was an ancillary project to the Framingham Heart Study. The presence of spondylolysis and spondylolisthesis as well as measurements of spinal geometry were identified on CT imaging of 188 individuals. Spinal geometry measurements included lordosis angle, wedging of each lumbar vertebra and intervertebral disc. Last measurements were used to calculate ΣB, the sum of the lumbar L1–L5 body wedge angles; and ΣD, the sum of the lumbar L1–L5 intervertebral disc angles. Using Wilcoxon–Mann–Whitney test we compared the geometric parameters between individuals with no pathology and ones with spondylolysis (with no listhesis) at L5 vertebra, ones with isthmic spondylolisthesis at L5–S1 level, and ones with degenerative spondylolisthesis at L5–S1 level. Spinal geometry in individuals with spondylolysis or listhesis at L5 shows three major patterns: In spondylolysis without listhesis, spinal morphology is similar to that of healthy individuals; In isthmic spondylolisthesis there is high lordosis angle, high L5 vertebral body wedging and very high L4–5 disc wedging; In degenerative spondylolisthesis, spinal morphology shows more lordotic wedging of the L5 vertebral body, and less lordotic wedging of intervertebral discs. In conclusion, there are unique geometrical features of the vertebrae and discs in spondylolysis or listhesis. These findings need to be reproduced in larger scale study.     

退变性腰椎侧凸的手术治疗及疗效

目的探讨退变性腰椎侧凸的后路手术方法和手术疗效。方法回顾性分析2007~2012年本院手术治疗并获得随访的32例退变性腰椎侧凸患者的手术方法及疗效。患者均接受腰椎后路减压椎间融合器植骨融合内固定术,术后随访6个月~6年。采用下腰痛Oswestry功能障碍指数(Oswestry disability index,ODI)对患者手术前后的临床症状进行评分和疗效评价;通过手术前后冠状位和矢状位Cobb角度的比较,了解患者手术治疗的侧凸矫正率和腰椎前凸的恢复情况。结果患者ODI术前(52.30±13.65)%、术后(9.62±6.41)%,术前术后比较差异有统计学意义(P0.05),术后疼痛改善率为81.6%。32例患者中,24例疗效为优,6例疗效为良,2例疗效为可,术后疗效评价的优良率为93.8%。患者冠状位Cobb角术前21.99°±8.97°、术后6.84°±5.32°,术前术后比较差异有统计学意义(P0.05),侧凸矫正率为69.0%。患者腰椎前凸Cobb角术前13.80°±15.99°、术后24.95°±12.86°,术前术后比较差异有统计学意义(P0.05)。结论退变性腰椎侧凸采用腰椎后路减压椎间融合器植骨融合椎弓根螺钉内固定术治疗效果较理想,术后疗效满意。手术的关键是彻底减压、正确选择融合节段、重建退变节段椎间高度、矫正前凸减少和后凸畸形、纠正椎体侧方移位和侧凸畸形以稳定椎体。     

The biomechanical influence of the facet joint orientation and the facet tropism in the lumbar spine

Background contextFacet joint orientation and facet tropism (FT) are presented as the potential anatomical predisposing factors for lumbar degenerative changes that may lead in turn to early degeneration and herniation of the corresponding disc or degenerative spondylolisthesis. However, no biomechanical study of this concept has been reported.PurposeTo investigate the biomechanical influence of the facet orientation and FT on stress on the corresponding segment.Study designFinite element analysis.MethodsThree models, F50, F55, and F60 were simulated with different facet joint orientations (50°, 55°, and 60° relative to coronal plane) at both L2–L3 facet joints. A FT model was also simulated to represent a 50° facet joint angle at the right side and a 60° facet joint angle at the left side in the L2–L3 segment. In each model, the intradiscal pressures were investigated under four pure moments and anterior shear force. Facet contact forces at the L2–L3 segment were also analyzed under extension and torsion moments and anterior shear force. This study was supported by 5000 CHF grant of 2011 AO Spine Research Korea fund. The authors of this study have no topic-specific potential conflicts of interest related to this study.ResultsThe F50, F55, and F60 models did not differ in the intradiscal pressures generated under four pure moments: but under anterior shear force, the F60 and FT models showed increases of intradiscal pressure. The F50 model under extension and the F60 model under torsion each generated an increase in facet contact force. In all conditions tested, the FT model yielded the greatest increase of intradiscal pressure and facet contact force of all the models.ConclusionsThe facet orientation per se did not increase disc stress or facet joint stress prominently at the corresponding level under four pure moments, but FT could make the corresponding segment more vulnerable to external moments or anterior shear force.     

CT辅助山羊腰椎解剖测量及与人体腰椎的对比研究

目的:通过对山羊腰椎的解剖测量以及与人体腰椎的对比研究,为腰椎假体的动物模型建立奠定基础。方法:通过计算机辅助软件Mimics 16.0对波尔山羊新鲜腰椎标本及健康成人腰椎的椎体、椎弓根、椎间盘等部位的解剖参数进行采集,最终运用统计学软件对两者腰椎解剖特点进行对比研究。结果:山羊椎体前高中高后高,最大值分别为(38.7±2.9)、(40.1±2.6)、(40.7±2.7)mm。其终板宽度大于其深度,整体呈心形或肾形外观。山羊上终板向外凸出,下终板凹陷较小,最大值为(1.6±0.6)mm。山羊椎弓根高自L1至L6不断增大,最大值为(30.5±1.9)mm;其椎弓根宽与夹角随着椎体序列的增加先减小后增大,最小值分别为(6.7±0.4)mm与(45.9±2.6)°。山羊椎间盘前高中高后高,三者随着椎间隙的变化数值波动较小;其椎间孔高与宽亦变化较小,分别在(12.9±0.3)~(14.3±1.0)mm与(5.7±1.0)~(6.7±0.9)mm波动。对比结果显示山羊腰椎椎体高、椎弓根高及夹角明显大于人类(P0.05),而其终板宽与深、椎间盘高等明显小于人类(P0.05)。此外,两者某些结构如椎弓根高、椎间盘高等随着椎体序数的增加亦呈现出不同变化规律。结论:山羊腰椎虽然在某些方面如终板及椎间孔形态等与人体存在相似性,但是在诸多方面仍存在较大差异。掌握山羊腰椎的解剖特点及与人体之间的差异对于腰椎假体及相关技术的山羊动物研究具有重要的指导意义。     

退变性腰椎滑脱与关节突关节的方向性

目的：探讨腰椎关节突关节的方向性在退性变腰椎滑脱发生中的病因学意义。方法：34例L4／5退变性腰椎滑脱患者及30名正常对照者的CT扫描片，侧位X线片上关节突关节的方向性及腰椎滑脱程度进行分析。结果：退变性腰椎滑脱患者的关节突关节方向与对照组比较更偏向吴矢状位（P＜0．01），关节突关节不对称程度也更为明显（P＜0．05），小关节椎弓根角更倾向于水平位（P＜0．01），关节突关节角，不对称程度及小关节椎弓根角与腰椎滑脱程度无显著相关性（P＞0．05）。结论：腰椎关节突关节的方向性在退变性腰椎滑脱的发生中可能有一定的病因学意义。