腰椎滑脱患者关节突关节形态的评价

目的 文章探讨关节突关节形态对腰椎滑脱的影响。方法 L4－5节段退变性滑脱25例（均年龄55岁），后滑脱12例（均年龄53岁）和峡部裂滑脱11例（均年龄44岁）与32例（均年龄47岁）正常人进行对照检查，CT轴向扫描关节突关节，测量L3－4，L－4，5L5－S1关节突关节角度，关节宽度，的深度和关节面形态。结果 由上向下关节角度逐步从矢状向冠状转化。在L4－5节段退变性滑脱患者关节角度方向与对照组相比明显偏向矢状（P＜0．01），退变性滑脱组和后滑脱组的关节宽度均大于对照组（P＜0．01），退变性滑脱组的关节面深度比有显著差异，峡部裂滑脱组的唯一差异是关节宽度显著减少（P＜0．01）。结论 结果提示关节突变状排列可能是生长过程中形成的，某些患者发生腰椎退变性时可能会出现滑脱。     

腰椎关节突关节不对称与腰椎椎间盘术后症状复发的关系

本文对１９３例腰椎椎间盘术后有／无症状复发进行自身前后的ＣＴ比较,结果发现,在腰椎椎间盘术后有症状复发的６３例中,有腰椎关节突出关节不对称者４８例,占７６．２％;而腰椎关节突关节对称者腰椎椎间盘术后症状复发１５例,占２３．８％,腰椎关节突出关节不对称引起腰椎椎间盘术后症状复发明显高于对称者（ｘ＾２＝１０１．０６,Ｐ〈０．００５）。结果提示：腰椎关节突关节不对称与腰椎椎间盘术后症状复发有显著关系,故     

腰椎滑脱患者关节突关节形态的评价

目的文章探讨关节突关节形态对腰椎滑脱的影响。方法L4～5节段退变性滑脱25例(均年龄55岁)、后滑脱12例(均年龄53岁)和峡部裂滑脱11例(均年龄44岁)与32例(均年龄47岁)正常人进行对照检查。CT轴向扫描关节突关节,测量L3～4、L4～5、L5～S1关节突关节角度、关节宽度、关节面的深度和关节面形态。结果由上向下关节角度逐步从矢状向冠状转化。在L4～5节段退变性滑脱患者关节角度方向与对照组相比明显偏向矢状(P<0.01),退变性滑脱组和后滑脱组的关节宽度均大于对照组(P<0.01),退变性滑脱组的关节面深度比也有显著差异。峡部裂滑脱组的唯一差异是关节宽度显著减少(P<0.01)。结论结果提示关节突关节矢状排列可能是生长过程中形成的,某些患者发生腰椎退变时可能会出现滑脱。     

关节突关节形态与退变性腰椎滑脱的关系

目的 探讨关节突关节形态与退变性腰椎滑脱的方法。方法 首先对41例60岁以下（平均年龄55岁）有L4－5退变性滑脱的患者和32例（平均年龄53岁）正常人进行对照检查。用CT轴向扫描关节突关节，测量L3－4，L4－5，L5－S1关节突关节的角度，关节横向，关节面的深度和观察关节面形态。第二部分研究分别测量40例40岁以下和40例60岁以肯要痛患者的关节突关节角度，观察其关节。结果 退变笥滑脱患者与对照组相比，L4－5节段关节角度方向明显偏向矢状面，关节角度不对称和关节面深度比也有显著差异。第二部分2组下腰痛患者的关节突关节角度无统计学差异。结论 60岁以下的退变性腰椎滑脱患者存在着关节突关节形态异常，L4－5节段关节或矢状排列和／或同时伴有关节角不对称是腰椎早期滑脱的危险因素。     

腰椎关节突关节不对称的研究进展

由腰椎关节突关节病变引起的脊柱疾病发病率正逐年上升,其中腰椎关节突关节不对称（LFT）与腰椎关节突关节骨性关节炎、腰椎间盘退行性变、退变性腰椎滑脱、脊柱侧凸等疾病相关。近年来,LFT对脊柱退变过程的影响已被广泛研究,这将对各类脊柱疾病的预防与诊疗起到重要的指导作用。因此,本文就LFT的研究现状作一综述。     

关节突关节形态对腰椎退变性疾病的影响

腰椎关节突关节（FJ）是椎体后的一对小关节,是腰椎节段的重要组成部分之一,具有引导、控制脊柱的运动方向、活动范围并承受脊柱一定负荷的作用。目前,FJ结构的异常如关节面角度改变、双侧角度不对称、纵向关节的形态移行变化等产生的原因及其对腰椎退变性疾病的影响,还不十分明确。有研究表明,关节形态的改变可来自先天或关节炎症后的重塑,且关节的异常形态可通过影响应力-应变关系和瞬时旋转轴,而造成FJ以及椎间盘的损伤和炎症,并致使腰椎发生退变性疾病。本文对FJ解剖结构异常的原因,及其生物力学机制和退行性变的过程进行综述,旨在为临床上FJ对腰椎退变性疾病影响的研究提供参考。     

下腰椎关节突关节的CT诊断

目的:提高下腰椎关节突关节的异常改变对椎间盘突出症诊断的重要性的认识。材料与方法:随机抽取临床症状、体征及CT表现典型的腰椎间盘突出症病例的CT片1 0 0份,对该症发生的部位、类型进行统计;同时对关节突关节角进行测量并对关节角差值≥1 0°的进行按节段分类统计;对关节突关节面的形态和相互关系按4种类型进行分类。结果:单个椎间盘突出占6 8%,两个椎间盘同时突出占3 1 %,共计1 3 1个椎间盘突出发生于L3、4的1 7个占1 2 . 98%;L4、5的6 7个占5 1. 1 4 %;L5、S1的4 7个占3 5 . 88%。双侧关节突关节角不对称共有83个,占2 7. 6 7%,其中L3、4水平1 5个占1 8. 0 7%;L4、5水平3 8个占4 5 78%;L5、S1水平3 0个占3 6 . 1 4 %。双侧关节突关节形态不对称改变6 1个椎体,占2 0 .3 %。呈Ⅰ、Ⅱ型的最多,计3 4 1个,占94 .46 %,呈Ⅲ、Ⅳ型改变共计2 0个,其中1 6个发生于L5、S1水平,3个发生于L4、5水平。结论:关节突关节角小,不对称及关节面呈Ⅲ、Ⅳ型改变是腰椎间退变和突出症的潜在病因学因素之一,因此,提高对关节突关节的异常改变的认识在腰椎间盘突出症的诊断中至关重要     

颈椎关节突关节的摄影方法

颈椎关节突关节位属一个新的投照体位~([1]),可显示颈椎关节突关节及相应关节间隙,在传统颈椎斜位的基础上增大20°～25°,使C3～C7关节突关节显示最佳,是一种相对客观的颈椎关节突关节X线投照方法.     

关节突关节在腰椎失稳中作用的研究进展

<正>历来不乏关于腰椎失稳的研究,目前被多数学者所认同并应用于临床的"腰椎失稳"定义是由Stokes和Frymoyer于1987年提出的:脊柱运动节段(function spinal unit,FSU)的刚度下降,生理载荷下脊柱运动节段的位移超出正常生理范围,以致出现脊柱畸形、神经症状和不能忍受的疼痛。生物力学试验证明,腰椎运动节段正常解剖结构的改变将导致腰椎节段性失稳。本文对     

关节突关节不对称与腰椎间盘突出位置的关系

目的:评估关节突关节不对称与腰椎间盘突出的关系。方法:96例单节段腰椎间盘突出患者,用CT测量关节突关节形态,与没有椎间盘突出的自身临近节段对照,比较两者之间的相关性。同时观察腰椎间盘突出位置与关节突关节方向的关系。结果:椎间盘突出在L4/5节段是56个(58.33%),在L5/S1节段是40个(41.66%)。59例突向左侧(61.46%),37例突出右侧(38.54%)。L4/5椎间盘突出节段存在关节不对称的为8/56,对照节段存在关节不对称的为2/40(P>0.05),L5/S1椎间盘突出节段存在关节不对称的为12/40,对照节段为4/56(P>0.05)。关节突关节不对称与腰椎间盘突出总体存在相关性(P<0.01)。关节突关节不对称与腰椎间盘突出在L5/S1节段存在相关(P<0.05),而在L4/5节段无相关(P>0.05)。腰椎间盘突出在哪一侧与关节突关节角度形态无关(P>0.05)。结论:关节突关节不对称与腰椎间盘突出存在相关,但突出的位置与关节角度无关。     

Mechanical back pain and the facet joint syndrome

Mechanical back pain is a common disability often associated with the facet joint syndrome. Treatment is based on early, adequate pain relief with simple techniques of regional analgesia. In a few cases this is not enough and more sophisticated methods, such as radiofrequency denervation, cryo-analgesia and possibly intrathecal midazolam, are necessary. However, the main thrust of our approach is to treat the underlying structural disorder with strengthening of the back muscles and correction of postural abnormalities responsible for the mechanical back pain. Our report is based on an analysis of 83 patients who failed to respond to long periods of rest, suitable analgesic and allied drugs and other non-invasive measures. There had been no overriding indication for major surgery. A large number of these patients have been improved by our methods, but further work is in progress to extend the proportion of satisfactory results.     

The provocative lumbar facet joint

Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.     

经皮腰椎椎板关节突螺钉引导器在椎板关节突螺钉植入中应用价值

目的 探讨自行设计的经皮腰椎椎板关节突螺钉引导器在椎板关节突螺钉植入中的安全性、准确性及临床应用价值.方法 腰椎退变性疾病患者52例,均行椎弓根钉联合对侧椎板关节突螺钉内固定、经椎间孔人路腰椎椎间融合术,根据椎板关节突螺钉植入方式分为引导器植入组25例和徒手植入组27例,比较2组手术时间、术中X线透视次数、术中出血量、...     

体操训练对下腰痛患者腰椎功能的影响

目的：探讨体操训练对下腰痛患者腰椎功能的影响。方法：将诊断下腰痛的１１０ 例患者随机分成两组,每组５５ 例,对照组按传统方法进行治疗,训练组同时进行体操训练。训练时间１～３ 个月（平均７０ｄ）。结果：两组腰椎功能评分均有提高,训练组比对照组改善率及改善指数提高明显（Ｐ＜０．０１） ． 结论：体操训练有助于腰椎功能的提高,并能预防下腰痛的复发。     

腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系

目的：研究腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系。方法：通过151例腰腿痛患者CT片观察椎间盘突出状况和测定关节突关节角度,其中73例患者还做了MRI检查,了解关节突关节不对称与椎间盘退变的关系。结果：关节突关节不对称与椎间盘退变和突出有关,而椎间盘突出方向与关节面的偏向无关。结论：关节突关节不对称增加了椎间盘退变和突出的危险性。     

Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review

Purpose: This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP).

Methods: Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works.

Results: Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed.

Conclusions: Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise.

• Implications for Rehabilitation

• Despite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles.

• To increase validity and reliability of the Biering-Sorensen test, concomitant activation of synergistic muscles should be taken into account.

• Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain.

• Body mass index, grading of pain and level of disability of the study population should be reported to enhance research quality.