MRI矢状位及轴位参数与退变性腰椎不稳的相关性

目的 分析MRI矢状位及轴位参数与退变性腰椎不稳的相关性.方法 选择本院2018年11月～2020年10月收治的123例腰痛患者作为研究对象,根据是否存在腰椎不稳分为稳定组73例和不稳组50例,均进行MRI矢状位及轴位扫描.比较两组的腰骶角、黄韧带厚度、小关节积液宽度、腰椎间盘退变分级、小关节退变分级.结果 稳定组的腰骶角、黄韧带厚度、小关节积液宽度显著低于不稳组,差异均有统计学意义(P<0.05).稳定组的腰椎间盘退变程度显著低于不稳组,差异有统计学意义(P<0.05).稳定组的小关节退变程度显著低于不稳组,差异有统计学意义(P<0.05).Pearson相关分析显示,腰骶角、黄韧带厚度、小关节积液宽度、腰椎间盘退变分级、小关节退变分级均与退变性腰椎不稳呈正相关(P<0.05).结论 MRI矢状位及轴位参数与退变性腰椎不稳有显著相关性,临床可根据患者腰骶角、黄韧带厚度等对退变性腰椎不稳进行防治.     

MRI下小关节积液与退变性腰椎滑脱症的关系研究

目的 探讨磁共振(magnetic resonance imaging, MRI)下小关节积液与退变性腰椎滑脱症的关系。方法 本研究选择2019年2月～2021年2月本院112例退变性腰椎滑脱症患者,男42例,女70例,年龄(61.33±5.93)岁;均为L_4-5滑脱。收集患者影像资料,MRI轴位片判断小关节积液情况,并设为积液组与未积液组。比较两组患者椎间盘Pfirrmann退变分级、椎体滑脱距离以及滑脱程度,并分析小关节积液宽度与Pfirrmann退变分级、椎体滑脱距离以及滑脱程度的相关性。结果 112例中,小关节积液54例,小关节积液平均宽度(2.90±0.45)mm。积液组病程、ODI指数显著高于未积液组(P<0.05);积液组Pfirrmann分级、椎体滑脱距离以及滑脱程度均显著高于未积液组(P<0.05);积液组小关节积液宽度与Pfirrmann分级、椎体滑脱距离以及滑脱程度均呈正相关关系(P<0.05)。结论 退变性腰椎滑脱症普遍存在腰椎小关节积液现象,且小关节积液与腰椎滑脱程度、椎间盘退变分级具有正相关关系,在退变性腰椎滑脱症的诊...     

继发性腰椎不稳

腰脊髓或神经根受压时，常需将致压物切除，这样就可能使腰椎的稳定结构受到不同程度的破坏，从而影响腰椎的稳定性，或者使原来已经不稳的腰椎变得更加不稳，这种情形被称为继发性腰椎不稳或医源性腰椎不稳。理想的腰椎管手术应该具备神经减压彻底、组织损伤小、保持或重建腰椎稳定性这     

取芯融合术治疗退行性腰椎不稳

目的探讨后路开窗取芯椎间植骨融合治疗退行性腰椎不稳的疗效。方法对57例退行性腰椎不稳患者进行后路开窗取芯椎间植骨融合治疗。结果 57例均获随访,时间14～50个月。按植骨融合情况、症状、功能恢复情况评定临床疗效：优43例（75.43%）,良11例（19.30%）,可2例（3.51%）,差1例（1.76%）,优良率为94.74%。结论退行性腰椎不稳导致的严重腰腿痛,经后路开窗取芯椎间植骨并辅以钉棒系统固定,是重建腰椎稳定性确实有效的治疗手段。     

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。     

椎间盘退变和关节突关节骨性关节炎对腰椎稳定性的影响

目的 探讨腰椎退变过程中，腰椎间盘退变、关节突关节骨性关节炎与腰椎稳定性之间的关系。方法 对78名腰椎退变患者进行腰椎MRI和动力位X线摄影。腰椎不稳分为椎间角度运动不稳、旋转不稳和椎间位移不稳，其中椎间位移不稳细分为：前向不稳、后向不稳和前后向不稳。腰椎间盘退变依据矢状位T2加权像分为5级；关节突关节骨性关节炎依据水平位T1加权像分为4级。对资料进行统计分析。结果 腰椎椎间角度运动不稳和前后向椎间位移不稳与关节突关节骨性关节炎存在显著负相关，前向椎间位移不稳与腰椎关节突关节骨性关节炎和椎间盘退变呈显著正相关，腰椎矢状面旋转不稳与腰椎关节突关节骨性关节炎无显著相关。结论 腰椎间盘退变和腰椎关节突关节骨性关节炎可影响腰椎运动节段的稳定性。     

腰椎关节突关节骨性关节炎对腰椎稳定性的影响

目的探讨腰椎退变过程中,腰椎间盘退变、关节突关节骨性关节炎与腰椎稳定性之间的关系.方法对78名腰椎退变患者进行腰椎MRI和动力位X线摄影.腰椎不稳分为椎间角度运动不稳、旋转不稳和椎间位移不稳,其中椎间位移不稳细分为前向不稳、后向不稳和前后向不稳.腰椎间盘退变依据矢状位T2加权像分为5级;关节突关节骨性关节炎依据水平位T1加权像分为4级.对资料进行统计分析.结果腰椎椎间角度运动不稳和前后向椎间位移不稳与关节突关节骨性关节炎存在显著负相关,前向椎间位移不稳与腰椎关节突关节骨性关节炎和椎间盘退变呈显著正相关,腰椎矢状面旋转不稳与腰椎关节突关节骨性关节炎无显著相关.结论腰椎间盘退变和腰椎关节突关节骨性关节炎可影响腰椎运动节段的稳定性.     

腰椎退变黄韧带的生物力学测定

目的:测定人腰椎黄韧带的生物力学指标,为研究黄韧带退变的力学机制提供依据.方法:30例腰椎退变患者为退变组,同时期的15例年轻腰椎外伤患者为对照组,黄韧带标本均取自两组患者L4/5间黄韧带.标本清洗、修剪后测量初始长度和横截面积.将标本固定在力学试验机上的夹具后,调零处理,对标本施加拉伸载荷,直至标本断裂,计算机自动输出实验数据,根据直接获得的位移、载荷数据.通过计算得出应变、应力以及弹性模量的数值,并对两组数据进行统计学分析.结果:对照组所能承受的最大拉力载荷为65.98±6.58N,退变组为81.39±8.32N;对照组位移为3.74±0.37mm,退变组为3.08±0.29mm:对照组应力为32.99±5.48MPa.退变组为41.59±3.72MPa;对照组应变为0.209±0.09,退变组为0.183±0.02;对照组弹性模量为157.79±5.76MPa,退变组为229.32±21.95MPa.各指标两组相比均有统计学意义(P＜0.05).结论:腰椎退变黄韧带与正常黄韧带相比,应力增加,应变降低,弹性模量增加.说明退变黄韧带抗拉伸作用增强,但弹性却降低.这可能与腰椎退变导致黄韧带受力改变有关.     

腰椎椎间小关节退行性变的研究进展

虽然腰椎退行性变的始动因素来源于椎间盘．但当发展至椎间盘退变、椎管狭窄时．腰椎椎间小关节承受的压力显著递增．将产生异常应力和异常运动．随之而来的是腰椎椎间小关节骨质增生，韧带代偿性增生肥厚，而这些又是椎间小关节源性腰痛产生的重要病理基础。单纯行腰椎椎间小关节融合或破坏椎间小关节会引起一些远期并发症。目前．已有很多关于腰椎椎间小关节生物力学稳定性重建的研究。基于此，笔者将从流行病学、生物力学以及外科治疗等方面对腰椎椎间小关节退形性变的研究进展作一综述。     

退变性腰椎不稳固定节段与邻近节段椎间盘退变的关系

目的探讨后路减压、固定、融合术后治疗退变性腰椎不稳的疗效,固定后邻近节段椎间盘退变发生机率与相关性。方法回顾性分析2005年8月～2010年8月下腰椎固定术180例患者的临床资料。结果随访1～5年,其中有症状性退变2例,均为固定近端相邻的椎间盘,而且此阶段椎间盘术前均有不同程度的退变。结论退变性腰椎不稳固定治疗后出现邻近节段椎间盘退变与腰椎固定及固定阶段多少本身无关,与固定前邻近节段椎间盘有无退变关系明显,且多发生于固定节段近端。     

The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study

The role of MRI in assessing facet joint osteoarthritis is unclear. By developing a grading system for severity of facet joint osteoarthritis on MRI, the relationship between disc degeneration and facet joint osteoarthritis was determined. The accuracy of MRI in assessing facet joint osteoarthritis against CT was 94%. Under 40 years of age, the degree of disc degeneration varied among individuals. Over the age of 60, most of the discs were markedly degenerated. Under 40 years of age osteoarthritic changes in facet joints were minimal. Over the age of 60, variable degrees of facet joint osteoarthritis were observed but some facets did not show osteoarthritis. No facet joint osteoarthritis was found in the absence of disc degeneration and most facet joint osteoarthritis appeared at the intervertebral levels with advanced disc degeneration. Disc degeneration is more closely associated with aging than with facet joint osteoarthritis. The present study supports the hypothesis that “disc degeneration precedes facet joint osteoarthritis”, and also supports the concept that it may take 20 or more years to develop facet joint osteoarthritis following the onset of disc degeneration. Received: 1 March 1999 Revised: 27 May 1999 Accepted: 4 June 1999     

腰椎小关节不对称与椎间盘变性

对54例年龄大部分在50岁以下、经保守治疗效果不明显的慢性腰痛患者，为进一步查明病因而作了CT扫描及MRI成像检查。应用CT扫描测量小关节角度并决定两侧小关节的对称性。用MRIT2加权像观察L3－4、L4-5和L5－S1水平的椎间盘有无变性。结果显示，由L3－4～L5－S1小关节角度逐渐增加。同一水平一侧小关节增大，即两侧小关节不对称与该节段的椎间盘变性有权明显的相关性。腰椎小关节不对称者，该节段椎间盘变性的发生率明显增加。作者认为，小关节不对称增加了椎间盘退变的危险性，可能是椎间盘早期发生退变的重要因素。     

腰椎不稳定与腰椎间盘退变程度的相关性分析

目的：探讨腰椎不稳定与腰椎间盘退变程度的相关性。方法：随机选择100例腰腿痛病人,根据第一病人的腰椎功能位X线片和腰椎MRI图片,确定椎间盘的退变程度及有无节段不稳,并分析二者间关系。结果：L3－S1共有36个节段不稳,占12％;腰椎不稳29例,占病人总数的29％,L4／5、L3／4、L5／S1的不稳定发生率分别为22％、10％和4％;腰椎不稳与病人年龄分组呈现密切正相关,腰椎不稳与单节段退变及总退变度密切正相关,结论：腰椎不稳与椎间盘退变和蔼密切相关,但并非严重退变一定会发生节段不稳。     

Chronology of disc degeneration and facet joint arthritis in lumbar spine is variable - A CT based cross-sectional study

BackgroundThe notion that disc degeneration (DD) always precedes facet joint arthritis (FJA) has held sway for many decades. However, it is not always the case. We hypothesized that DD is not always the first offender studied the prevalence of isolated DD and isolated FJA in the lumbar spine.MethodsInter-vertebral discs and bilateral facet joints of lumbar spines of 135 participants were graded. The participants were divided into one of the four categories. ‘No degeneration,’ ‘Isolated disc degeneration without facet joint arthritis,’ ‘Combined disc degeneration and facet joint arthritis,’ and ‘Isolated facet joint arthritis without disc degeneration.’ Multivariate logistic regression analysis was done to evaluate the predictive factors for spinal degeneration using FJA as a dependent variable while age, sex, BMI, smoking history, and DD as predictor variables.ResultsThe majority of participants had isolated FJA 64 (47.4%). Combined DD and FJA were noted in 32 (23.7%), isolated DD in 8 (5.9%), while 31(23%) had no degeneration. Only age was found to be significantly contributing to the prediction model in multivariate analysis.ConclusionOur study shows that spinal degeneration may begin either in the disc or in the facet joints depending upon the aetiological factors. It is a vicious circle that may be entered at any point, FJA or DD.     

Ligamentum flavum cyst in the lumbar spine: a case report and review of the literature

Degenerative changes in the lumbar spine can be followed by cystic changes. Most reported intraspinal cysts are ganglion or synovial cysts. Ligamentum flavum pseudocyst, as a cystic lesion in the lumbar spine, is a rare and unusual cause of neurologic signs and symptoms and is usually seen in elderly persons (due to degenerative changes). They are preferentially located in the lower lumbar region, while cervical localization is rare. Complete removal of the cyst leads to excellent results and seems to preclude recurrence. We report the case of a right-sided ligamentum flavum cyst occurring at L3–L4 level in a 70-year-old woman, which was surgically removed with excellent postoperative results and complete resolution of symptoms. In addition, we discuss and review reports in the literature.     

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。     

腰椎管狭窄症合并黄韧带囊肿1例报道

正患者,男,69岁,主因"腰痛伴左下肢疼痛1年,伴间歇性跛行5个月,加重2个月"于2016年11月7日入院。患者1年前左下肢疼痛,以左臀部及大腿外后侧为重,为间断性钝痛,5个月前出现间歇性跛行,4个月核磁检查:L_(4,5)间盘水平左侧黄韧带内见一小类圆形长T1长T2信号影,边界清晰,硬膜囊受     

The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain

Facet tropism has been investigated as a predisposing factor for degenerative changes in the lumbar spine; however, no prior study has evaluated the relationship between disc bulge and facet tropism. In this study, we used kinetic magnetic resonance imaging (kMRI) to investigate the association between degree of facet tropism and amount of disc bulge in the lumbar spine in relation to age. kMRIs in the flexion, neutral, and extension positions were performed on 410 consecutive patients with low back pain. T2-weighted midsagittal and axial mid-disc cuts were analyzed to measure disc bulge and facet angle. Facet asymmetry was calculated and classified as: no facet tropism, <6°; mild facet tropism, 6–11°; or severe facet tropism, ≥11°. Maximal static bulge (MSB), maximal dynamic bulge (MDB), and age in the facet tropism groups were compared by age subpopulations and MDB categories, defined by the positions between which the largest change in disc bulge occurs. We found the severe facet tropism group to be associated with a nearly significant increase in MSB and MDB over the no facet tropism group in the older subpopulation at the L4–L5 level only, and a larger MDB in the L4–L5 MDB category [E–N], where the greatest change in disc bulge occurs between neutral and extension positions (p = 0.013). Our findings suggest that severe facet tropism is associated with increased disc bulge at L4–L5 in only a subset of older age patients, but may in large part be due to biomechanical factors that define the [E–N] category.     

Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum.

The innervation of lumbar facet capsule and ligamentum flavum was investigated using antisera to a general neuronal marker protein gene product (PGP) 9.5 and to peptide markers of sensory nerves (calcitonin gene-related peptide [CGRP] and substance P) and autonomic nerves (vasoactive intestinal polypeptide [VIP] and C-flanking peptide of neuropeptide Y [CPON]). In the facet capsule (n = 14), PGP 9.5 and CGRP-immunoreactive nerves occurred in 12 and five specimens, respectively, both around blood vessels and as free fibers in the stroma. Free fibers immunoreactive for substance P or VIP were noted in three and five specimens, whereas in nine specimens there were CPON-immunoreactive nerves located perivascularly. There was no immunoreactivity in the ligamentum flavum. This study provides further evidence that the facet capsule but not the ligamentum flavum has substantial innervation by sensory and autonomic nerve fibers and has a structural basis for pain perception.     

退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析

目的:分析退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)中腰椎-骨盆结构特点及其在退变性腰椎滑脱症中的意义。方法:对2015年4月至2017年1月收治的45例单纯退行性L_4,5节段腰椎滑脱患者(滑脱组)的临床资料进行回顾性分析,并与同期50例(对照组)体检资料齐全的健康者进行比较。通过影像学资料对受试者的腰椎-骨盆结构参数进行统计分析,分析DLS患者的脊柱-骨盆特点。观察退变性腰椎滑脱患者椎间盘及关节突关节退变特点。利用Spearson分析各观察项目之间的相关性。结果:滑脱组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(36.5±11.2)°、(44.2±7.3)°、(66.5±11.6)°、(22.2±10.0)°、(33.4±11.3)°。对照组L_4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(44.4±8.2)°、(36.7±8.5)°、(55.4±13.2)°、(14.4±7.0)°、(42.3±13.1)°,滑...