退变性腰椎滑脱与腰椎小关节形态改变相关性分析

目的通过腰椎小关节的骨关节炎分级、关节矢状角、终板下关节角在不同滑脱程度的退变性腰椎滑脱患者中的改变,探讨退变性腰椎滑脱程度与腰椎小关节形态相关性。方法回顾性分析2009年10月～2011年11月L4/5退变性腰椎滑脱患者43例,Ⅰ度退变性腰椎滑脱29例为A组,Ⅱ度退变性腰椎滑脱14例为B组;Weishaupt关节炎影像学法对L4/5小关节炎进行分级;CT测量L4/5小关节矢状角、L4终板下关节角。不同退变性腰椎滑脱组的骨关节炎分级,关节矢状角和L4终板下关节角及两侧对称性比较。结果 A组和B组骨关节炎均无0级,其中,A组1、2、3级分别为4、11、14例;B组分别为1、6、7例,两组骨关节炎分级无差异（P〉0.05）。A组L4/5关节矢状角、L4终板下关节角（28.69±8.97）°、（115.91±6.51）°]与B组（28.23±11.89）°、（117.90±7.23）°]比较,差异无统计学意义（P〉0.05）;两侧关节矢状角对称性差异、终板下关节角对称性差异A组（9.06±4.45）°、（5.21±3.90）°]与B组（12.80±4.95）°、（8.25±3.62）°]比较,差异有统计学意义（P〈0.05）。结论腰椎小关节矢状角、终板下关节角的不对称性影响退变性腰椎滑脱的滑脱程度。

Correlation analysis between lumbar facets joints and degenerative lumbar spondylolisthesis

Objective To study the correlation between the lumbar degenerative spondylolisthesis （LDS） and the morphologic of the lumbar facet joints through the changes of the lumber arthritis and the sagittal orientation of zygapophysial joints and the hypozyga-endplate angles. Methods 43 specimens of LDS were collected form October 2009 to November 2011. A group was the 29 specimens of L4/5 with I° LDS and B group was the 14 specimens of L4/5 with Ⅱ° LDS. Computed tomography was used to describe the grading of lumbar facet joints degeneration by Weishaupt method. The facet joints orientation in the horizontal plane of L4/5 and the hypozyga-endplate angles of L4 were surveyed and evaluated through CT. The parameters of the grading of lumbar facet joints degeneration and the sagittal orientation of zygapophysial joint and the hypozyga endplate angle and the symmetry between two groups were compared. Results There was no zero degree between two groups. The specimens of the grading of lumbar facet joints degeneration were 4/11/14 in 1/2/3 degree in A group and the specimens were 1/6/7 in B group. It had not statistic significance between two groups （P 〉 0.05）. The sagittal orientation of zygapophysial joint of L4/5 and its angle subtraction and the hypozyga-endplate angle of L4 were （28.69±8.97）° and （115.91±6.51）° in A group, and （28.23±11.89）° and （117.90±7.23）° in B group. The parameters had statistic significance （P 〉 0.05）. The asymmetry of the sagittal orientation of zygapophysial joint of L4/5 and the hypozyga-endplate angle of L4 were （9.06±4.45）°and （5.21±3.90）° in A group, （12.80±4.95）° and （8.25±3.62）° in B group. The asymmetry had statistic significance in two groups （P〈 0.05）. Conclusion The asymmetry of the sagittal orientation of zygapophysial joint diminished and the hypozyga-endplate angle increases the degree of lumbar degenerative spondylolisthesis.