腰椎小关节综合征CT诊断分析(附22例报告)

目的:介绍腰椎小关节综合征的CT诊断征象及其临床价值。材料与方法:分析22例腰椎小关节征的CT表现及其常见伴随征象。结果:CT直接一次性显示小关节面骨质改变,关节间隙改变,关节囊改变以及伴随的椎间盘膨出、突出,椎间孔、侧隐窝和椎管狭窄,黄韧带肥厚、钙化等征象。结论:CT可以为腰椎小关节综合征的诊断提供直观、充分的影像学根据,可作为本征的首选检查。     

腰椎椎小关节综合征的CT诊断价值

目的：强调在实际工作中应对腰椎椎小关节综合征加以重视。方法：结合文献及CT征象对腰椎椎小关节病变的分析。结果：L4-5节段是椎小关节病变好发部位。结论：CT检查对本病诊断有重要意义。     

腰椎小关节面综合征的CT表现及其临床意义

目的 探讨腰椎小关节面综合征CT影像表现及其临床意义.方法 回顾分析51例腰椎小关节面综合征CT影像表现和临床资料,并与同期采用同样扫描方法 获得11例青壮年正常腰椎小关节CT图像进行对比.结果 腰椎小关节面综合征CT表现为:①关节突增生肥大;②椎小关节间隙变窄;③关节内真空征象;④关节面毛糙硬化;⑤小关节半脱位;⑥小关节周围钙化⑦其他伴随征象.结论 腰椎小关节面综合征CT表现多种多样,应全面分析.     

多层螺旋CT曲面重建成像技术在诊断腰椎小关节病中的应用

目的：探讨多层螺旋CT曲面重建成像技术在诊断腰椎小关节病中的应用价值。方法：对28例临床拟诊腰椎小关节病患者行腰2-骶1多层螺旋CT平扫，并对腰椎小关节进行多角度曲面重建成像。结果：诊断腰椎小关节病20例，其中关节突增生、硬化、变形12例；关节间隙左右不对称变窄或增宽19例；关节面毛糙、硬化10例；关节间隙内真空征5例。腰椎小关节CT表现正常8例。结论：多层螺旋CT曲面重建成像能全面、直观地显示腰椎小关节，为腰椎小关节病的诊断提供了可靠的影像学依据。     

腰椎小关节曲面重建成像的应用及其价值

目的探讨多层螺旋CT曲面重建成像在诊断腰椎小关节病中的应用价值。方法对42例临床拟诊腰椎关节病患者行L2-S1多层螺旋CT平扫．并对腰椎小关节进行多角度曲面重建成像。结果本组共诊断腰椎小关节病35例．其中关节突增生．硬化、变形19例：关节间隙左右不对称变窄或增宽32例；关节面毛糙17例：关节间隙内真空征11例。结论多层螺旋CT曲面重建成像能全面、直观地显示腰椎小关节，为腰椎小关节病的诊断提供了可靠的影像学依据。     

椎小关节变性与腰椎滑脱-CT表现和联系

目的：观察椎小关节变性不稳定变与腰椎滑脱之间的关系。方法：分析25例腰椎滑脱而未见椎弓峡部断裂患者的腰椎CT，主要观察滑脱椎体小关节的情况。结果：椎小关节不同程度的退行性变，表现有关节突增生硬化、肥大及碎裂。椎小关节面毛糙、间隙狭窄消失，小关节半脱位等。结论：部分腰椎滑脱仅与椎小关节变性不稳定变有关，CT可以清晰显示。     

MSCT在腰椎小关节综合征诊断中的临床应用研究

目的：探讨多层螺旋CT（MSCT）合并三维后处理对腰椎小关节综合征诊断中的价值。方法对180例经临床或相关提示腰椎小关节综合征患者的MSCT进行回顾性分析,三维后处理采用曲面重建（CPR）、容积再现（VTR）和多平面重建（MPR）等技术进行重建,分析椎间小关节病变情况。结果180例病人中发现椎间关节病变161例,发现椎间关节病变左侧共353个,右侧391个,双侧255个,其中椎间关节增生、硬化、肥大104例,椎间关节狭窄87例,椎间关节变性31例,椎间关节半脱位33例,合并其他病变如椎间盘病变91例,黄韧带肥厚45例,椎体侧弯36例,椎管狭窄19例,椎体滑移21例。结论 MSCT合并三维后处理可充分显示椎间小关节的解剖结构及病理变化,对诊断腰椎小关节综合征具有一定的影像学价值。     

CT诊断腰椎小关节退变的临床意义

腰椎小关节退变是腰椎退变的重要组成部分，是引起患者腰腿痛的常见原因。但在临床工作中常被忽视，相关文献把椎小关节退变伴腰腿痛命名为椎小关节综合征。本组收集了130例有腰椎小关节退变CT表现的病例，综合分析如下。     

下腰椎小关节退行性病变的X线、CT、MRI影像学比较

目的探讨X线、CT和MRI对下腰椎小关节退行性病变的诊断价值及局限性。方法收集41例明确有下腰椎小关节退行性病变的X线、CT和MRI影像学资料,包括腰椎正、侧、斜位及过伸、过屈位片,L3～S1段椎小关节CT横断位及MRI横断、冠状、矢状位扫描图像。结果X线平片对腰椎小关节的显示仅限于对关节面骨质及关节间隙宽窄度改变的观察。CT对椎小关节突骨质、关节面平整度及关节面下骨质、关节间隙、关节囊钙化等改变的显示明显优于X线平片及MRI（均P〈0．05）。MRI在显示关节面软骨、关节囊肿胀、滑膜囊肿及滑膜囊疝等方面明显优于X线平片和CT（均P〈0．05）。结论X线平片、CT、MRI三种影像学检查方法在显示椎小关节退行性病变方面各有优缺点,综合应用和合理选择影像学检查方法可为临床正确诊断和治疗腰椎小关节病变提供可靠依据。     

强直性脊柱炎骶髂关节、腰椎小关节及髋关节的CT表现

目的探讨强直性脊柱炎(AS)受累骶髂关节、腰椎小关节及髋关节的病变CT表现特点,以提高诊断与鉴别诊断水平。方法 2011年1月-10月对临床确诊的强直性脊柱炎患者44例骶髂关节、28例腰椎及14例髋关节行CT扫描,回顾性分析骶髂关节、腰椎小关节及髋关节的CT表现。结果 AS患者的CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧,腰椎小关节及髋关节则表现为关节间隙改变、关节面毛糙及囊状破坏、面下骨硬化或吸收等改变。结论 AS骶髂关节、腰椎小关节及髋关节的CT表现具有一定特征,CT具有重要的诊断及鉴别诊断价值。     

腰椎小关节综合征的影像学诊断

目的：探讨腰椎小关节综合征的影像学表现。材料与方法：回顾性分析84例腰腿痛病人的CT和X线平片,CT发现腰椎小关节异常53例,平片发现24例。结果：腰椎小关节综合征的CT表现为小关节突增生肥大,骨赘形成,关节间隙狭窄,关节面下囊变,关节内真空现象,关节囊钙化,侧隐窝狭窄等,后4方面普通X线平片检查难以显示。结论：CT可为腰椎小关节综合征的诊断提供可靠的影像学依据,对腰腿痛病人的合理施治有重要意义。     

Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging

ObjectiveThe purpose of this study was to determine the reliability of the assessment of lumbar facet joint degeneration severity by analyzing degeneration subscales using magnetic resonance imaging (MRI) in human participants.MethodsThe reliability of articular cartilage degeneration, subchondral bone sclerosis, and osteophyte formation subscales of lumbar facet joint degeneration severity was assessed in MRI images from n = 10 human participants. Each scale was applied to n = 20 lumbar facet joints (L4/5 level). Three examiners were trained. A first assessment of MRI images was provided by the examiners followed by a second assessment 30 days later. Intraobserver and interobserver reliability were determined using percent agreement, the weighted kappa coefficient κ_w for paired comparisons, and the overall weighted kappa κ_o. The minimum threshold for reliability was set at moderate levels of agreement, κ_w > 0.40, based upon previous recommendations.ResultsThe articular cartilage subscale had acceptable intraobserver (κ_o = 0.51) and interobserver (κ_o = 0.41) reliability. Scales for subchondral bone sclerosis (intraobserver κ_o = 0.28; interobserver κ_o = 0.10) and osteophyte formation (intraobserver κ_o = 0.26; interobserver κ_o = 0.20) did not achieve acceptable reliability.ConclusionOf the 3 subcategories of lumbar facet joint degeneration, only articular cartilage degeneration demonstrated acceptable reliability. Subscales of lumbar facet joint degeneration should be considered independently for reliability before combining subscales for a global degeneration score. Owing to the inherent difficulty of assessing lumbar facet joint degeneration, the use of multiple examiners independently assessing degeneration with reliable scales and then coming to a consensus score upon any disagreements is recommended for future clinical studies.     

多排螺旋CT对成人腰椎小关节病的诊断价值

目的:探讨多排螺旋CT对成人腰椎小关节病的诊断价值及临床意义.方法:回顾性分析临床及影像资料齐全的71例腰椎小关节病,对发病的腰椎小关节形态、病变数目、椎间盘形态及密度等指标进行了观察.结果:所有病例均有多排螺旋CT检查,其中52例同时有X线检查.腰椎小关节病的多排螺旋CT表现关节突增生肥大56例,小关节间隙变窄49例,32例关节面凹凸不平并伴有骨性关节面下小的囊性变.18例腰椎小关节内出现真空征象,12例关节脱位或半脱位,7例椎小关节囊钙化,表现为小关节间隙内或外侧缘出现新月形钙化.同时合并椎问盘膨出25例,椎间盘突出37例.在52例X线片中,23例椎小关节模糊,间隙狭窄,同时伴有骨质增生硬化,29例未发现确切的异常征象.结论:X线对腰椎小关节病的诊断仅限于对关节面骨质及关节间隙宽窄度的评价,而多排螺旋CT是诊断成人腰椎小关节病的首选方法,它能清楚地鉴别椎小关节病和椎间盘病变.     

12. Pain Originating from the Lumbar Facet Joints

Although the existence of a “facet syndrome” had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low‐level trauma, leading to inflammation and stretching of the joint capsule. The most frequent complaint is axial low back pain with referred pain perceived in the flank, hip, and thigh. No physical examination findings are pathognomonic for diagnosis. The strongest indicator for lumbar facet pain is pain reduction after anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Because false‐positive and, possibly, false‐negative results may occur, results must be interpreted carefully. In patients with injection‐confirmed zygapophysial joint pain, procedural interventions can be undertaken in the context of a multidisciplinary, multimodal treatment regimen that includes pharmacotherapy, physical therapy and regular exercise, and, if indicated, psychotherapy. Currently, the “gold standard” for treating facetogenic pain is radiofrequency treatment (1 B+). The evidence supporting intra‐articular corticosteroids is limited; hence, this should be reserved for those individuals who do not respond to radiofrequency treatment (2 B±).     

单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病

目的：探讨单侧置钉经椎间孔的椎体融合（transforaminal lumbar interbody fusion,TLIF）术结合经椎板关节突螺钉治疗退行性腰椎疾病的手术方法及疗效。方法：2009年3月—2009年11月,23例退行性腰椎疾病（包括腰椎退行性滑脱合并腰椎不稳定的腰椎管狭窄）患者,采用单侧置钉TLIF术结合经椎板的关节突螺钉治疗。术后随访6~12个月（平均8个月）。评价患者术后下肢及腰背部疼痛[视觉模拟评分（VAS评分）]、影像学表现、以及围手术期患者并发症。结果：所有患者围手术期中均未发生血管、神经损伤等严重并发症,1例出现经椎板关节突螺钉置钉位置不佳引起神经根刺激症状,行二期手术取钉后症状缓解。所有患者术后下肢及腰背部疼痛的VSA评分明显优于术前。影像学随访未见内固定失败及矫形丢失现象。结论：采用单侧置钉TLIF术,结合经椎板关节突螺钉,可以有效地治疗退行性腰椎疾病。手术创伤小,疗效肯定。     

Morphologic Evaluation of Cervical and Lumbar Facet Joints: Intra‐Articular Facet Block Considerations

Study Design: Needle orientations for lumbar and cervical facet injection were measured in cadavers and compared with facet angles measured on magnetic resonance images (MRIs). Objectives: To establish facet orientation relative to clinical procedures of a facet joint block in the cervical and lumbar spine. Methods: Needle orientation angles were measured from 20 unembalmed human cadaveric specimens (13 cervical and 7 lumbar). Spinal needles were inserted into the midpoints of the facet joint spaces from C3 to C7 and L1 to L5. Needle trajectories were measured with an optical tracking system. For comparison, facet angles from 100 clinical MRIs of lumbar spines were also measured. Facet orientations on MRIs were measured at their intersection with the transverse plane, and angles were quantified using image analysis software. Results: Typical angles for insertion of the needle into the cervical facets were oriented closer to the coronal plane, whereas insertion angles for lumbar needles were oriented closer to the sagittal plane. Relative to the sagittal plane, the mean cervical angle was 72 degrees and the mean lumbar angle was 33 degrees. The insertion points of the cervical facets were a mean of 29 mm from the midsagittal plane compared with a mean of 22 mm for the lumbar facets. MRI‐based facet joint angles correlated poorly with actual injection angles, which were overestimated 5 to 23 degrees, depending on the lumbar level. Conclusions: Knowledge of the quantitative anatomy of the facets may help improve clinical diagnosis and treatment. These data also may aid in constructing more realistic computer simulations.     

腰椎小关节病的CT检查和表现

目的 对腰椎小关节病ＣＴ表现作出归纳,提高对此病作为腰腿痛的重要病因的认识。方法连续２００例腰腿痛患,主要作了腰椎Ｌ４－５和Ｌ５－Ｓ１的小关节ＣＴ平扫,并运用骨窗和软组织窗对图像进行分析和测量。结果 有１３５例（占６７．５％）患表现为不同节段的腰椎小关节病,ＣＴ表现为：骨赘形成;小关节突增生肥大;关节间隙变窄;关节真空现象以及关节囊的钙化等。腰椎小关节病常伴有其它腰椎疾病。讨论 腰椎小关节病是