腰椎小关节紊乱症临床症状与影象学相关性的研究

目的:利用X线和CT检查手段,观察、测量该症在影像学表现,从临床症状、体征与影像学表现上进行统计分析,找出诊断依据。方法:门诊随机选择年龄在50岁以下,无慢性腰痛病史的患者58例,治疗前详细询问病史,查体。行X线、CT检查,采用手法治疗。并对X线和CT结果进行测量、分析。结果:本组病例X线测量有病变棘突中线偏离者48例占82.7%,小关节间隙不等宽49例占86.2%,小关节模糊不清8例占13.8%,脊柱侧弯41例占71%。CT检查主要表现为两侧小关节间隙不对称,椎小关节面骨质硬化,小关节突密度不均匀,关节面不光整,韧带钙化等.。小关节角测量,患椎与健椎比较无明显差别,有牵涉性疼痛12例占20.68%。结论:急性腰椎小关节紊乱符合滑膜嵌顿的特点。棘突偏斜与小关节不等宽同时存在,棘突偏斜部位与压痛部位一致,腰椎侧弯其程度与疼痛程度有关,与是否有放射痛无关。CT小关节角变化与临床症状无明显关联。结合病史、临床症状和体征,X线、CT检查,腰椎侧弯、棘突偏斜、小关节不等宽可作为临床诊断依据。

Relationship between Clinical Symptoms of Lumbar Small Joint Disorder and Its Imaging Material

Objective：To observe and summarize the performance of lumbar joint disorder on X-ray and CT,so as to find out the diagnostic basis from the clinical symptoms,signs and its imaging information.Methods：All 58 cases,enrolled at random,were under 50 years old and with no history of chronic back pain.Before manual therapy,there would be an inquiry and physical examination in detail.Meanwhile,the results of X-ray and CT before and after the therapy were recorded.Results：Forty-eight cases（82.7%） showed spinous process deviation on X-Ray,forty-nine cases（86.2%） had uneven small joint space,eight cases（13.8%） showed unclear joint imaging,and forty-one cases（71%） displayed scoliosis.The main performances on CT were asymmetrical small joint space,osteosclerosis,uneven density,unsmoothness articular surface,and ligament calcification.There was no distinguished difference in the joint angle between normal and abnormal vertebrae.Twelve cases presented referred pain,accounting for 20.68%.Conclusion：Acute lumbar small joint disorder is characteristic of synovialis incarceration.Spinous deflection and uneven small joint space co-existed,and the spot containing spinous process deviation is right the position having tenderness.There degree of scoliosis is associated with pain severity,while has nothing to do with radiating pain.Joint angle change on CT shows no significant correlation to clinical symptoms.With the medical history,clinical symptoms and physical sign,X-ray and CT examination,lumbar lateral deflection,spinous deflection,and uneven small joint space can be used as a clinical diagnosis standard.