腰椎小关节退变致腰腿痛机制的实验研究

目的：探讨退变腰椎小关节病变和腰腿疼的关系及其可能的作用机制。方法：收集我院骨科临床手术中切除的腰椎小关节标本，利用组织病理学和影像学检查对比研究正常和退变腰椎小关节的病变特点，免疫组织化学方法观察P物质（substance P，SP）、降钙素基因相关肽（calcitonin gene-related peptide．CGRP）能神经纤维在小关节中的分布，酶联免疫吸附剂测定法（enzyme-linked immunosobnent assay，ELISA）测定腰椎小关节中细胞因子IL-1β的含量。结果：退变腰椎小关节的X线和CT表现为关节间隙有不同程度的变窄或消失、关节面骨质增生、硬化，HE染色软骨表面不平整、细胞排列紊乱；白介素-1β（interleukin-1β，IL-1β）水平升高。在两组小关节中都发现了SP、CGRP能神经纤维的存在。结论：腰椎小关节退变后发生了不同程度的病理变化，机械摩擦和细胞因子刺激小关节中的神经纤维可能是小关节病变引起腰腿疼的原因之一。     

高应力导致兔腰椎小关节骨性关节炎的实验研究

目的:观察兔腰椎小关节加载应力后小关节在应力作用下的病理变化,并探讨其病理机制。方法:将42只新西兰白兔随机分为正常对照组(A组)、椎间盘退变组(B组)、小关节加力组(C组)及椎间盘退变及小关节加力组(D组)。对B组和D组动物采用针刺抽吸髓核法建立椎间盘退变模型,建模6周后分别对C组和D组的L3/4、L5/6小关节加载拉簧造成高应力模型,对A组和B组仅行小关节暴露,分别于术后4个月、8个月取腰椎小关节,采用番红O-快绿染色,进行Mankin评分判断软骨退变程度并分为轻度、中度及重度;免疫组化染色观察细胞因子IL-1β、IL-6、TNF-α在小关节软骨中的表达。结果:不同组间小关节退变程度有显著性差异(F=92.77,P=0.000),组内比较,各组8个月时小关节退变程度较4个月时严重(P<0.05);同一时间段不同组间比较,小关节加力组(C组和D组)的小关节退变程度较小关节未加力组(A组和B组)严重,差异均有显著性(P<0.05),A、B组间及C、D组间比较,小关节退变程度无显著性差异(P>0.05)。三种细胞因子随着软骨退变程度的增加而表达增强,而严重退变的软骨由于软骨细胞数减少表达反而有所下降。结论:高应力可导致腰椎小关节退变,应力作用时间越长,小关节退变越严重。腰椎小关节软骨细胞的退变伴随着炎性细胞因子合成、分泌的改变。     

腰椎退变性滑脱CT诊断

目的 探讨腰椎退变性滑脱CT扫描价值,发病机理及临床意义。方法 分析35例退变性滑脱CT结果。结果 前滑脱30例,后滑脱5例;椎间小关节退变35例;椎间盘膨出20例。结论 椎间小关节及椎间退变是腰椎退变性滑脱的重要原因。     

退变性腰椎滑脱后路内固定后不同融合方式疗效评价

退变性腰椎滑脱主要指由于腰椎不稳、小关节突退变增生、椎间盘退变等下腰部退行性病变导致的腰椎滑脱,其峡部一般完整,因此又称假性滑脱,其发生率为各种病因所致腰椎滑脱的60%以上。退变性腰椎滑脱发生于腰椎退变的基础之上,绝大多数合并腰椎管狭窄,后路减压后经椎弓根螺钉复位固定是目前被普遍接受的术式。在融合方法上主     

腰椎关节突关节退变的影像学改变及意义

腰椎关节突关节退变是导致下腰痛(low back pain)的主要原因之一,严重影响广大人民群众的生活质量.本文认真总结近年来国内外学者对于腰椎关节突关节退变的研究进展,概括了关节突退变的X线、CT及MRI表现及其临床意义,尤其是MRI表现国内相关报道较少,旨在为国内学者今后进行相关领域更深入的临床研究提供思路和参考.     

腰椎不稳的临床特点与影像学表现观察

[目的]探讨腰椎不稳定的X线、CT、MRI三者与临床特点的关系。[方法]分析55例腰椎不稳定患者的X线、CT、MRI的影像学资料和临床特点。[结果]通过站立位腰椎X线过伸过屈侧位像结合临床表现诊断出腰椎不稳的患者中，分析CT表现可以显示出小关节的退变病理变化；MRI主要显示椎间盘的退变病理过程。[结论]X线并结合临床特点可以诊断腰椎不稳定症；CT和MRI可以进一步说明腰椎不稳定症的病理基础。     

骨质疏松症对脊柱小关节退变的影响

骨质疏松症(OP)以骨量减少和骨的微细结构破坏为主要特征,并伴随骨质脆性增加和骨折危险性升高.由于骨的结构破坏,可引发脊柱退行性变,使椎体高度丢失应力改变及使人体成骨、破骨细胞代谢紊乱,发生脊柱尤其是腰椎小关节退变.但由骨质疏松症引起脊柱小关节退变尤其是腰椎小关节退变原因发病机制文献报道较少,目前认为骨质疏松对脊柱小关节退变与成骨,破骨细胞代谢影响,及发生椎体内微骨折,改变椎体高度及软骨下骨血供应微环境,增加小关节应力,减少其血供营养有关.     

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。     

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。     

磁共振在退变性腰椎稳定性评估中的临床价值

目的 探讨磁共振在退变性腰椎评估中的的临床价值及相关性。方法 回顾性分析于2020年8月至2022年8月本院收治的71例疑似不稳定性腰椎退行性变的患者的临床及影像学资料。根据其腰椎的稳定情况分为稳定组31例和不稳定组40例。观察比较两组患者的椎间盘退变退变情况、小关节退变情况、腰骶角、黄韧带厚度和小关节积液厚度。结果 不稳组患者的腰椎间盘退变、小关节退变情况，较稳定组更为严重，差异具备统计意义，P<0.05。不稳组的腰骶角和小关节积液厚度均大于稳定组，差异具备统计意义，P<0.05；而两组患者的黄韧带厚度的比较差异不显著，P>0.05。结论 磁共振能够在椎间盘退变、小关节退变、腰骶角和小关节积液厚度等方面对腰椎的稳定性具有较好评估能力，值得临床使用。     

分析腰椎小关节病的CT常见表现

目的回顾性分析腰小关节病的CT表现。方法选择68例腰椎小关节病患者,分析CT影像改变并记录临床表现。结果68例患者表现为不同节段的腰椎小关节改变,CT表现为骨赘形成,关节突增生肥大,关节面软骨破坏,关节间隙变窄,关节真空现象,关节囊的钙化和囊肿等。结论腰椎小关节病是引起腰痛及腰腿痛的重要病因之一,常合并腰椎间盘退变。由于以往检查技术的局限以及过分强调了椎间盘的作用,造成对此病的认识不足,小关节病CT表现特异性强,对此病的诊断和治疗均有重要指导意义。     

Detailed pathological changes of human lumbar facet joints L1–L5 in elderly individuals

Facet joints play an important role in intervertebral load transmission and are crucial for rotational kinematics. Clinically, the role of facet joints as a possible source of low back pain is seen as controversial and at present is not sufficiently investigated. In this study, human lumbar facet (zygapopyhysial) joints from donors with advanced age were analyzed macroscopically, for degenerative changes. The aim was to determine the extent and morphology of degenerative changes in these joints. Lumbar facet joints (L1–L5) of 32 donors were studied (mean age 80.1±11.2 years). Joint capsules were carefully removed and joint surfaces (5 zones) examined using magnifying glasses and probes. In the result, the majority of facet joints showed cartilage defects of varying extent. Defects were located mostly at the margins of the articular surface, the central zone being relatively well preserved. Defect localization was different between superior (most cartilage defects in superior zone) and inferior (most defects inferiorly) facets. Further, defects were more severe caudal (level of L5) and in older persons. Osteophytes were present in up to 30%, located mostly at the latero-dorsal enthesis of the joint capsule on the superior facet. In conclusion, most margins of the articular facets are subject to degenerative changes in the lumbar spine of elderly persons, the topographical pattern being different in superior and inferior facets. This observation can be explained by the segmental motion patterns during extension/flexion movements of the facets. Sometimes, due to the marginal extension, it is obvious that not all changes can be assessed by CT or MRI.     

The configuration of the laminas and facet joints in degenerative spondylolisthesis. A clinicoradiologic study

The configuratory variation of laminas and facet joints was discussed with reference to development of degenerative spondylolisthesis and its clinical symptoms. The authors have classified the configuration of laminas in the lower lumbar spine into three different types, (WI, W2, and N), based on the two characteristic features of the lamina: 1) whether or not the inferior articular processes are wider than the waist part of the lamina, and 2) whether or not the facet joint spaces can be recognized on plain anteroposterior (AP) radiographs. Types W1 and W2 laminas have the laterally prominent inferior articular processes, but the facet joint spaces are not visible on AP view in Type W1. Type N lamina has narrow inferior articular processes and its facet joint spaces can be recognized on AP view. Computed tomography (CT) scanning revealed that the direction of facet joints of Types W2 and N laminas was more sagittal than that of Type W1, and that all of Type N laminas with the narrow inferior articular processes have a sagittal facet. Type N lamina was rarely seen in the 257 controls, but was quite frequent in degenerative spondylolisthesis, 3.5% and 45.8%, respectively. Patients with Type N laminas were likely to show more severe clinical symptoms such as difficulty walking and neurologic deficits.(ABSTRACT TRUNCATED AT 250 WORDS)     

下腰椎小关节的方向性与椎间盘突出和侧隐窝狭窄的关系

目的探讨下腰椎小关节的方向性在椎间盘突出的发生和侧隐窝狭窄的形成中的作用和影响。方法通过腰椎ＣＴ片对下腰椎小关节角度进行测量,并分析、研究小关节的对称性、方向性与椎间盘突出和侧隐窝狭窄的关系。共观察１３６例患者３８６个下腰椎间隙的ＣＴ影像,采用横切关节面角度（ＴＩＦＡ）测量法,测量了７７２个下腰椎小关节角度。结果（１）下腰椎椎间盘突出与小关节对称性无关;（２）在Ｌ４～Ｓ１小关节不对称的间隙中,椎间盘易突向矢状小关节侧;（３）小关节角度小于２０度易发生退行性侧隐窝狭窄症;（４）该组测量的国人下腰椎小关节角度明显小于西方学者测量的欧洲人的角度。结论（１）下腰椎高发椎间盘突出症为特殊体位导致的应力集中所致,与椎间小关节方向性无关;（２）在Ｌ４～Ｓ１椎间隙中,如果椎小关节角度不对称将影响椎间盘突出的方向;（３）下腰椎小关节角度太小易导致退行性侧隐窝狭窄的发生。     

椎小关节综合征的CT表现

目的评价CT对椎小关节综合征的诊断价值。方法回顾性分析426例椎小关节综合征患者的CT表现。男性265例,女性161例,平均年龄53(36~72)岁。颈椎63例,胸椎11例,腰椎352例。结果单纯小关节病54例,余372例均合并其他椎关节疾病。颈椎、胸椎小关节病CT表现特点以椎小关节突的增生肥大(67例,90.54%)、硬化(53例,71.62%)、关节间隙变窄(47例,63.51%)和关节周围韧带骨化(48例,64.86%)为主征。腰椎小关节病的CT表现复杂,综合有:小关节突肥大、增生、骨桥形成306例(86.93%),小关节间隙狭窄或消失185例(52.56%),骨质关节面下有囊状破坏130例(36.93%),关节囊及周围组织钙化226例(64.20%),椎小关节间隙增宽或两侧不对称时有椎体滑脱改变36例(10.23%),关节腔“真空”征82例(23.30%);以多种影像并存为特点。结论CT可充分地显示椎小关节的解剖结构和病理改变,为小关节病的诊断提供了可靠的影像学根据。     

Early histologic changes in lower lumbar discs and facet joints and their correlation

Biomechanical and histologic studies have highlighted the close functional relationship between lumbar discs and their associated facet joints, and it is conceivable that their degenerative changes are interdependent. However, separation of cause from effect remains controversial. Hitherto, no study in humans has correlated the changes histologically. The present study assessed histologic changes in lower lumbar discs and their associated facet joints in patients under the age of 40 years using classification systems developed for this investigation. A specific objective was to correlate changes in discs and facet joints. Data from 15 lower lumbar spine specimens were obtained. Three parasagittal sections per disc and one section per facet joint were graded histologically. The results were correlated with age, within the functional spinal unit (FSU), and with the adjacent level. Histologic changes were found in discs and facet joints from all FSUs. There was no correlation between the age of the subject and the degree of degeneration of the disc or facet joints at either level. The extent of disc degeneration at L4/5 correlated significantly with changes at L5/S1 (P < 0.01). There was no correlation between changes in discs and the associated facet joints at either level. The results of the study showed that microscopic changes are seen in the disc and facet joints from an early age and can be quite marked in some individuals before the age of 40 years. A correlation of degenerative changes within the FSU could not be established. Received: 24 February 1999 /Revised: 1 September 1999 /Accepted: 16 September 1999     

腰后关节紊乱症的病机和手法治疗生物力学研究

用微型传感器埋入法，测定腰椎后关节在不同姿势下的位移和受力情况，结果表明：其位移程度和方向受关节突形态的影响，脊柱活动时关节内压力集中在小关节的上端和下端，当某段关节失稳时，较邻近的小关节内压力增大８倍左右。对模拟旋转手法测定表明：后关节内压力呈波浪状变化，其下关节突出现向上→前→下→后的全方位移动。作者从生物力学的角度对腰后关节紊乱症的病机和手法治疗原理进行了探讨。     

Prevalence of facet joint degeneration in association with intervertebral joint degeneration in a sample of organ donors

Among the most common causes of low back pain are strain on the muscles and ligaments associated with the spine, degeneration of the intervertebral discs (IVDs), and osteoarthritis of the facet joints. It is not clear, however, how these latter two conditions are related to each other in terms of their development during a patient's lifetime. The facet joint is the sole synovial joint of the spine but because it is difficult to image its degenerative history as well as its relationship to other degenerative factors within the spine remain elusive. We compared the gross and histologic characteristics of the lumbar spine from a sample of organ donors to the integrity of their associated IVDs as assessed through magnetic resonance imaging. In our study sample, we found that facet joint degeneration was common, occurring as early as 15 years of age, while the IVD could still remain intact. Facet degeneration was more severe at the L4/5 level and progressed along with IVD degeneration with age. Because such early degenerative changes in the facet joint are somewhat surprising, degeneration of this joint should not be overlooked when assessing OA of the spine and causes of lower back pain. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1267–1274, 2011     

Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study

We conducted this study to develop an ultrasound-guided approach for facet joint injections of the lumbar spine. Five zygapophyseal joints (L1-S1) on each side of 5 embalmed cadavers were examined by ultrasound for a total of 50 examinations. The joint space was demonstrated under ultrasound guidance. The midpoint of the joint space, defined as the middle of its cranio-caudal extension on its dorsal surface, was taken as a reference point, and its position was computed from its depth and lateral distance from the spinous process. Forty-two of 50 approaches could be clearly visualized. Subsequently, these distances were compared to those obtained by computed tomography (CT). To assess the efficacy of ultrasound in the needle placement, all lumbar facet joints were approached in one embalmed cadaver. The exact placement of the needle tips was again evaluated by CT. Ultrasound and CT measurements showed the same mean depth and lateral distance to the reference point, 3.15 +/- 0.5 cm and 1.9 +/- 0.6 cm, respectively. Pearson's coefficient of correlation was 0.86 (P < 0.0001) between ultrasound and CT. All 10 needle tips were within the joint space during simulated facet joint injections. We conclude that ultrasound guidance might be a useful adjunct for facet joint injections in the lumbar spine. IMPLICATIONS: This study was designed to develop an ultrasound-guided approach to the facet joints of the lumbar spine and to assess its feasibility and accuracy by means of a comparison to computed tomography images. The imaging study demonstrated a significant correlation between ultrasound and computed tomography measurements. During simulated facet injection, ultrasound guidance consistently resulted in accurate needle placement.     

Facet joint hypertrophy: The cross-sectional area of the superior articular process of L4 and L5

With CT imaging, the lumbar facet joints are well visualised and enlargement secondary to degeneration may be noted. We measured the cross-sectional area of the superior articular process of the L5 facet joint in 100 consecutive CT scans and in 71 patients, the L4 process was also measured. We found that the mean cross-sectional area was significantly larger at L5 than at L4. Patient age and sex had no significant effect on the size at either L4 or L5. A review of the radiological reports revealed that the 13 patients with degenerative facet joints and radiologically normal discs did not have significantly larger facet joints than the 35 patients with disc disease and radiologically normal facet joints. In conclusion, the term facet joint hypertrophy should not be used when osteoarthritic changes are noted on CT scan, because these joints are not significantly larger than normal facet joints.