腰椎小关节矢状化与腰椎退变性疾病之间的相关性分析及相互作用机制的初步探讨

发布时间：2018-03-23 16:31

本文选题：腰椎小关节　切入点：角度　出处：《南昌大学》2017年博士论文

【摘要】：研究背景和目的:近年来,人们开始对腰椎小关节进行细致的研究,大多数研究小关节炎引起腰痛的发生发展机制,其中腰椎间盘退变在中老年人群中发病率比较普遍,这是导致患者腰腿痛的最主要原因,腰椎活动过程中会引起腰椎小关节位置也发生相应的改变,而腰椎小关节的退变也会影响腰椎间盘的变化,腰椎小关节活动的方向与它的生物力学功能或者与各种病态改变的相关性仍存在很大争议。而在研究小关节矢状化方面仍较少。正常情况下,小关节的矢状面朝向有利于脊柱的前屈后伸活动,而限制轴向旋转。研究表明小关节矢状化与多重因素相关,本研究将通过系统的分析其中主要包括年龄、BMI、椎间盘的退变、腰椎滑脱以、PI及腰椎小关节炎等相关的主要影响因素,从而来初步探讨腰椎小关节矢状化与这些因素的关系。以往的研究大多数考虑单因素方面对小关节面角矢状化的影响。从人体解剖学可知,腰椎活动功能单位是由前侧的椎间盘和后方两侧的关节突关节构成,从而形成的稳定结构——三关节复合体,维持前屈、后仰以及侧弯等基本活动。本研究旨在初步探讨腰椎小关节矢状化在年龄、BMI、椎间盘的退变、腰椎滑脱PI以及腰椎小关节炎中的发病机制,为进一步研究小关节矢状化的具体发病机制奠定基础,从而也引起人们对小关节矢状化的进一步认识。研究内容和方法:1.腰椎小关节角度与年龄、BMI之间的相关性研究首先按年龄段≤30岁、31-40、41-50、51-60、61-70、70岁划分为6个组,每组规定30名患者。严格按照纳入、排除标准以及入选分组要求,经过严格匹配后,共收集2014年9月至2016年10月我院骨科门诊及住院的符合入选的标准患者180例。要求所有患者均摄有L3~4、L4~5、L5~S1三个节段的腰椎小关节磁共振的清晰图像,并获取T2WI横断位图像,用于评估小关节角度测定,以及对每位患者进行身高及体重的测定计算BMI值,所有收集到的数据通过SPSS统计软件进行统计分析。比较不同年龄段间小关节角度的变化情况,以及BMI与小关节角度之间的关系,探讨年龄、BMI与小关节角度之间相关性。2.腰椎小关节角度与腰椎间盘退变程度之间的相关性研究收集从2014年9月至2016年10月期间我院骨科住院及门诊有腰椎间盘退变患者共600例,进行回顾性分析:首先按照腰椎间盘退变的严重程度分为轻、中、重度3组,每组入60名,共180名患者。严格按照纳入、排除标准,及经过年龄、性别及体重指数严格匹配后共收集我院骨科住院的腰椎间盘退变患者180例。所有病例组均采用3.0T磁共振对L4-5腰椎间盘及腰椎小关节进行扫描,获取T2WI横断位图像,分别用于评估腰椎间盘退变的分级及小关节角度测定,比较不同椎间盘退变的程度与腰椎小关节角度之间的关系。3.腰椎小关节角度与骨盆入射角之间的相关性研究回顾性分析我院2013年3月至2016年10月符合入选标准的患者共450例,所有病例均摄有腰椎MRI及站立位腰椎正侧位X线片,在腰椎MRI横断位图像上测量小关节面角;在X线片上测量骨盆入射角(pelvic incidence,PI)。然后将所有病例依据PI测量角度分为小于正常范围组(≤35.5°)、正常范围组(35.5°—54.7°)、大于正常范围组(≥54.7°),每组30名患者,总共90名符合要求的患者。根据PI分组,比较各组间的小关节面角变化情况,初步探索小关节面角的变化与PI之间的相关性,收集数据进行统计学分析。4.腰椎小关节角度与退行性腰椎滑脱之间的相关性研究对2015年9-2016年10月在我院骨科门诊及住院的300例退变性腰椎滑脱患者及200名无症状人员的检查资料进行回顾性分析,最后符合入选标准及排除标准的共收集了病例组40名病例和对照组40名病例,要求所有病例组和对照组均有腰椎MRI影像资料,并于椎间盘横轴位扫描图像上测量L4-5椎间小关节角度。对比分析滑脱患者与正常人群小关节角度之间的差别。采用SPSS23.0对测得的数据进行分析,计量资料采用独立样本t检验。5.腰椎小关节角度与腰椎小关节炎之间的相关性研究结果:1、腰椎小关节角度与年龄、BMI之间的相关性研究收集2014年01月-2016年02月于南昌大学第一附属医院骨科住院确诊为腰椎小关节骨性关节炎患者共300例。再依据纳入与排除标准进行严格筛选后,共有60名患者符合纳入标准。要求所有病例组均有腰椎CT和MRI影像资料,并于椎间盘横轴位扫描图像上测量L4-5椎间小关节角度。对比分析小关节炎影像学上退变分级与小关节角度之间的差别。采用SPSS23.0对测得的数据进行分析,计量资料采用独立样本t检验,相关性分析采用pearson检验。(1)将年龄分成6个年龄段,即6个年龄组,每个年龄段在分别与L3~4、L4~5及L5~S1三个腰椎节段的小关节角度比较,发现病例组各节段的腰椎小关节角度与各年龄段之间具有明显统计学差异(P0.001);经过统计分析年龄与各各节段小关节角度之间具有高度相关性(L3~4 r=0.959、L4~5 r=0.794及L5~S1r=0.967)。(2)病例组各节段的小关节角度与BMI(21.31±1.56)之间无明显统计学差异(P0.05)。2、腰椎小关节角度与腰椎间盘退变程度之间的相关性研究L4~5腰椎小关节角度与腰椎间盘退变程度之间具有明显统计学差异(P0.01);腰椎间盘退变分级与小关节角度之间具有一定地相关性(r=0.46)。3、腰椎小关节角度与骨盆入射角之间的相关性研究L4~L5腰椎小关节角度的变化与骨盆入射角之间具有明显统计差异(P0.01),且随着骨盆入射角的增大,本身的腰椎小关节角度逐渐减小,二者之间具有高度的相关性(r=0.926)。4、腰椎小关节角度与退行性腰椎滑脱之间的相关性研究对照组和病例组间腰椎小关节角度具有明显统计学差异(P0.01),小关节角度在退行性腰椎滑脱病患中明显减小。5、腰椎小关节角度与腰椎退小关节炎之间的相关性研究经过分析比较后发现,腰椎小关节角度的变化与小关节不同退变程度具有明显差异(P0.05),小关节角度随着小关节退变程度的加重逐渐减小(r=-0518)。结论:1、在腰椎上,随着腰椎节段位置的下移,横断位小关节角度逐渐减小;且小关节角度的矢状化与年龄呈正相关,而与BMI及性别无明显相关,这可能年龄的增加会更容易引起小关节退变从而导致角度的矢状化。2、L4-5小关节角度的矢状化与腰椎间盘退变之间呈正相关,推测腰椎间盘退变的是引起小关节角度的矢状化的主要因素。3、PI大于正常范围可导致或加重L4~5段小关节角度的矢状化;PI与L4~5节段小关节角度的矢状化显著相关。4、正常对照组和退行性腰椎滑脱组之间腰椎小关节角度矢状化呈正相关,表明退行性腰椎滑脱可能是致腰椎小关节矢状化的另一个主要因素。5、腰椎小关节角度随着小关节退变程度的加重,越倾向矢状化,这说明小关节的退变很可能是引起小关节矢状化的重要因素,进而导致腰椎不稳定性。
[Abstract]:Background and purpose: in recent years, people began to conduct a detailed study of the lumbar facet joint arthritis caused by small, most of the mechanism of the occurrence and development of pain, including lumbar disc degeneration in the elderly population in the incidence is relatively common, this is the main cause of low back pain, lumbar activities can cause lumbar small joint position is changed correspondingly, and the lumbar facet joint degeneration will also affect the changes of lumbar intervertebral disc, lumbar facet joint activities and the direction of its biomechanical function or correlation with various pathological changes is still controversial. In the study of the sagittal orientation of facet joints is still less. Under normal circumstances, vector sagittal facet for a spine flexion and extension, and the limit of axial rotation. The research showed that the sagittal orientation of facet joints is associated with multiple factors, this study through the analysis of the system Mainly including age, BMI, intervertebral disc degeneration, spondylolisthesis, main influencing factors of PI and lumbar facet joint arthritis related, in order to investigate the relationship between the lumbar sagittal orientation of facet joints with these factors. The majority of previous studies consider the impact on the joint angle of sagittal single factors. We can see from the human anatomy, lumbar spine functional unit is composed of the front disc and rear sides of the facet joint, stability of the three joint complex, thus forming the structure to maintain flexion, lateral bending and backward basic activities. The purpose of this study is to explore the lumbar sagittal orientation of facet joints in age, BMI, intervertebral disc degeneration, lumbar spondylolisthesis and lumbar facet joint inflammation in PI pathogenesis, lays the foundation for the further study of pathogenesis of sagittal orientation of facet joints, which also caused people to further recognize the sagittal orientation of facet joints. General. The research contents and methods: 1. lumbar facet joint angle and age, correlation between BMI at age less than 30 years, 31-40,41-50,51-60,61-70,70 years old were divided into 6 groups, each group 30 patients. In strict accordance with the inclusion, exclusion criteria and the selected grouping requirements, through strict matching, were collected from September 2014 to October 2016 the Department of orthopedics of our hospital outpatient and inpatient 180 cases were enrolled. All patients were taken L3~4, L4~5, L5~S1 clear images of the three segments of the lumbar facet joint magnetic resonance, and get the T2WI axial images, for the assessment of small joint angle measurement, and for each patient were calculated BMI value determination of height and the weight of all the collected data were analyzed by SPSS statistical software. To compare the changes of different ages between the facet joint angle, and the relationship between BMI and the small joint angle between, To investigate the correlation between age, during the period between the BMI and the small joint angle correlation.2. orientation of lumbar facet joint and lumbar disc degeneration were collected from September 2014 to October 2016 in our hospital inpatient and outpatient department of orthopedics with lumbar disc degeneration in patients with a total of 600 cases were retrospectively analyzed: firstly, according to the severity of lumbar disc degeneration were divided into light in 3, severe group, each group of 60, a total of 180 patients. In strict accordance with the inclusion, exclusion criteria, and by age, sex and body mass index, after strict were collected in our hospital admitted to the Department of orthopedics of the lumbar disc degeneration in patients with 180 cases. All cases were used 3.0T magnetic resonance scanning of the lumbar L4-5 the intervertebral disc and facet joint, obtain transverse T2WI images, respectively for the assessment and classification of lumbar disc degeneration and facet joint angle measured between different degree of intervertebral disc degeneration and lumbar facet joint angle Review of the research on correlation between.3. angle and pelvic lumbar facet joint angle of incidence analysis in our hospital from March 2013 to October 2016, the criteria for patients with a total of 450 cases, all cases were taken MRI of the lumbar spine and standing lateral lumbar spine X-ray in lumbar transverse MRI images on the measurement of joint angle measurement; pelvic incidence in X-ray angle (pelvic incidence, PI). Then all cases were based on PI angle measurement is divided into less than the normal group (less than 35.5 degrees), normal group (35.5 degrees - 54.7 degrees), more than the normal group (54.7 degrees), each group of 30 patients, a total of 90 meet the requirements patients. According to the PI group, the facet joints were compared between groups angle changes, explore the correlation between the changes of PI and joint angle of the collected data were statistically analyzed with.4. orientation of lumbar facet joint and lumbar degenerative sliding correlation between research and Study on 9-2016 2015 October were retrospectively analyzed in the Department of orthopedics in our hospital and 300 patients with degenerative lumbar spondylolisthesis patients and 200 asymptomatic persons of the inspection data, finally met the inclusion criteria and exclusion criteria were collected from case group 40 cases and control group of 40 cases, all patients and the control group have lumbar MRI image data, and measurement of L4-5 facetjoint angle on disc axial scan images. A comparative analysis between the spondylolisthesis patients and normal population small joint angle difference. Using SPSS23.0 to analyze the measured data, the measurement data using correlation between independent samples t test.5. of lumbar facet joint and lumbar small angle arthritis results: 1, the angle of facet joint in age, study the correlation between BMI from 2014 01 months -2016 years 02 months in the Department of orthopedics in the First Affiliated Hospital of Nanchang University Diagnosis of lumbar facet osteoarthritis patients were 300 cases. According to the inclusion and exclusion criteria for rigorous screening, a total of 60 patients met the inclusion criteria. All cases group were lumbar CT and MRI image data, and measurement of L4-5 lumbar facet joint angle in intervertebral disc axial scan image contrast analysis. Small arthritis image degeneration classification and small joint angle on the difference. Using SPSS23.0 to analyze the measured data, the measurement data using independent samples t test, correlation analysis using Pearson test. (1) the age into 6 age, 6 age group, each age in respectively with L3~4 relatively small, joint angle L4~5 and L5~S1 the three lumbar segment, with statistically significant difference between lumbar facet joint angle of each segment of the case group and the age (P0.001); after statistical analysis of age and each segment There is a high correlation between the small joint angle (L3~4 r=0.959, L4~5 r=0.794 and L5~S1r=0.967). (2) the small joint angle cases each segment with BMI (21.31 + 1.56) was no significant difference between.2 (P0.05), with significant difference between the study of the correlation between the L4~5 angle and the degree of lumbar facet joint of lumbar facet joint angle and lumbar disc degeneration of the intervertebral disc degeneration (P0.01); has a certain correlation between the angle of lumbar disc degeneration and facet classification (r=0.46).3, with obvious statistical differences between the incident angle and pelvic changes between lumbar facet angle and pelvic angle to study the correlation between L4~L5 of lumbar facet joint angle (P0.01), and with the increasing of pelvic incidence, lumbar facet joint angle is decreased gradually, with a high degree of correlation between the two (r=0.926).4, lumbar facet joint angle and degenerative lumbar Study on the correlation between the control group and the slippage between cases of lumbar facet joint angle has significant difference (P0.01), small angle of joint in degenerative lumbar spondylolisthesis patients significantly decreased.5, orientation of lumbar facet joint and lumbar back relationship between small arthritis through comparative analysis found that the changes of lumbar facet joint angle with different degree of degeneration of facet joint has obvious difference (P0.05), small joint angle decreases with the increase of the degree of facet joint degeneration (r=-0518). Conclusion: 1, in the lumbar spine, with lumbar segment position shift, axial joint angle reduces gradually; and the sagittal orientation of facet joint and age the angle, BMI and gender was not related to age, which may increase would be more likely to cause facet degeneration resulting in sagittal.2 angle, sagittal L4-5 and facet joint angle of lumbar disc back Positive correlation between, that lumbar disc degeneration is caused by the sagittal facet joint angle of.3, PI higher than the normal range can cause or aggravate L4~5 segment facet joint angle of sagittal; sagittal PI and L4~5 segment of small joint angle of.4 was significantly correlated positively, normal lumbar the joint angle of sagittal correlation between group and group showed degenerative lumbar spondylolisthesis, degenerative spondylolisthesis.5 may be another main factor causing lumbar sagittal orientation of facet joints of lumbar facet joint angle with aggravation of facet degeneration degree, the more likely the sagittal orientation of facet joint degeneration, which is likely to be an important factor to cause the sagittal orientation of facet joints, causing lumbar instability.

【学位授予单位】：南昌大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R681.5

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