腰椎退变与不稳的影像学研究

目的：探讨椎间盘退变、小关节骨关节炎与腰椎退变性不稳3者之间的关系。方法：分析120个下腰痛患者的核磁共振影像与脊柱功能位X线片，腰椎不稳分为成角不稳，旋转不稳和水平不稳；椎间盘退变根据T2加权相被分为5级；小关节骨关节炎在T1加权相上被分为4级。结果：椎间盘退变程度和年龄成正相关，差异有显著性意义（P〈0．01）；有26．8％（93个）节段出现腰椎不稳，其中以椎间盘退变程度为1，2级的节段最为多见，与其他各级相比差异有极显著性意义（P〈0．01）；椎间盘退变和小关节骨关节炎呈正相关（J=0．937，P〈0．05），向前水平不稳和椎间盘退变和小关节骨关节炎明显相关，差异成极显著性（P〈0．01）。结论：放射影像测量的腰椎不稳定和小关节骨关节炎和椎间盘退变有明确的相关性。

The relationship between degeneration and instability of lumbar spine: study of imaging

Objective: To discuss the relationship along disc degeneration, fecet joint osteoarthritis and the instability of the degenerative lumbar spine. Methods: 120 patients suffering from lower back pain were analyzed adopting both MRI and X-rays of flexion and extension radiographs for the lumbar spine. The instability of lumbar spine was classified into abnormal tilting on flexion, rotatory instability in the sagittal plane, and translatory instability. Disc degeneration was classified into five grades according to T2-weighted sagittal images. Facet joint osteoarthritis as seen on axial T1-weighted images was divided into four grades. Results: On three intervertebral level, the grade of disc degeneration increased significantly (P<0.01) with age. Lumbar instability could be identified within 93 segments(26.3%) and correlated with grade 1 and grade 2 degeneration of the intervertebral discs(P<0.01). The kinematics of the lumbar motion segment were correlated with facet joint osteoarthritis(r=0.937,P<0.05). Anterior translatory instability was positively associated with disc degeneration and facet joint osteoarthritis(P<0.01). Conclusions: There is a positive relationship along the type of instability, disc degeneration and facet joint osteoarthritis.