中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (24): 3845-3851.doi: 10.3969/j.issn.2095-4344.1295

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

腰椎MRI评价椎间小关节积液与退变性腰椎滑脱稳定性的相关性

马钧峰1,2,汪  伟1,王紫括3,江泽华2,龙明星1,袁建军2,朱如森2,胡  炜2,张学利2
  

  1. 1天津医科大学研究生院,天津市  300070; 2天津市人民医院脊柱外科,天津市  300121;3河南省人民医院,河南省郑州市  450003
  • 出版日期:2019-08-28 发布日期:2019-08-28
  • 通讯作者: 张学利,主任医师,天津市人民医院脊柱外科,天津市 300121
  • 作者简介:马钧峰,男,1992年生,天津医科大学在读硕士,主要从事脊柱外科方面的研究。
  • 基金资助:
    天津市卫生计生委科技基金(16KG158),项目负责人:朱如森

Correlation between facet joint effusion in magnetic resonance imaging and lumbar stability after interspinous and degenerative lumbar spondylolisthesis

Ma Junfeng1, 2, Wang Wei1, Wang Zikuo3, Jiang Zehua2, Long Mingxing1, Yuan Jianjun2, Zhu Rusen2, Hu Wei2, Zhang Xueli2 
  

  1. 1Graduate School, Tianjin Medical University, Tianjin 300070, China; 2Department of Spinal Surgery, Tianjin People’s Hospital, Tianjin 300121, China; 3Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
  • Online:2019-08-28 Published:2019-08-28
  • Contact: Zhang Xueli, Chief physician, Department of Spinal Surgery, Tianjin People’s Hospital, Tianjin 300121, China
  • About author:Ma Junfeng, Master candidate, Graduate School, Tianjin Medical University, Tianjin 300070, China; Department of Spinal Surgery, Tianjin People’s Hospital, Tianjin 300121, China
  • Supported by:
    the Science and Technology Fund of Tianjin Health and Family Planning Commission, No. 16KG158 (to ZRS)

摘要:

文章快速阅读:


文题释义:
腰椎椎间小关节积液:关节积液是滑膜炎症反应程度的反应变量,椎间小关节是典型的滑膜关节,腰椎失稳后之间小关节的磨损引起积液量的增多,可在腰椎MRI上呈椎间小关节腔内T2加权像高信号表现,因此椎间小关节积液量的变化可以反映腰椎的稳定性程度。
腰椎滑脱稳定性:目前临床上对腰椎滑脱稳定性的诊断多借助腰椎动力位侧位X射线诊断,但诊断标准缺乏统一标准,并且对于神经症状较重的患者,X射线检查存在加重症状、检查过程痛苦的风险,因此通过有效的判断指标衡量腰椎稳定性意义重大。
 
摘要
背景:临床中对腰椎滑脱患者腰椎稳定性的诊断多借助腰椎侧位屈伸X射线,但该检查存在一定的局限,因此寻找可靠的腰椎稳定性预测指标十分必要。
目的:通过回顾患者影像学资料,分析退变性腰椎滑脱患者腰椎椎间小关节积液是否与腰椎稳定性存在相关性。
方法:回顾性分析2016年12月至2018年1月在天津市人民医院脊柱外科就诊的L4-5节段腰椎退变性滑脱患者共108例,所有患者对测量方案知情同意,且得到医院伦理委员会批准。根据其滑脱节段的腰椎MRI中是否出现椎间小关节腔内积液将患者分为无积液组55例,有积液组53例,并对2组进行对比分析。对有积液组中的双侧椎间小关节积液宽度和与矢状位椎体动态滑移指数、椎体旋转度、双侧椎间小关节退变指数和及椎间盘退变指数分别进行相关性分析。
结果与结论:①无积液组的失稳率低于有积液组,动态滑移量、动态滑移指数及矢状位旋转度均小于有积液组,椎间小关节及椎间盘退变程度均高于有积液组,差异均有显著性意义(P=0.000);②对于有积液组的相关性分析,双侧椎间小关节积液宽度和分别与矢状位椎体动态滑移指数、矢状位椎体旋转度成线性正相关(r=0.710,P=0.000;r=0.452,P=0.001);双侧椎间小关节积液宽度和分别与双侧椎间小关节退变指数和、椎间盘退变指数成负相关(r=-0.630,P=0.000;r=-0.648,P=0.000);③提示退变性腰椎滑脱症患者腰椎MRI上存在椎间小关节积液表现可提示滑脱不稳定,滑脱节段椎间小关节总积液量与腰椎滑移不稳定性、旋转不稳定性成正相关,与双侧椎间小关节退变程度、椎间盘退变程度成负相关。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0003-0872-3265(马钧峰)

关键词: 椎间小关节积液, 腰椎MRI, 腰椎滑脱, 腰椎稳定性, 椎间盘退变, 相关性分析

Abstract:

BACKGROUND: Clinically, the diagnosis of lumbar spine stability in patients with lumbar spondylolisthesis is mostly based on lumbar lateral flexion and extension X-ray, but this examination has certain limitations, so it is necessary to find a reliable predictor of lumbar stability.
OBJECTIVE: To evaluate the correlation between facet joint effusion and lumbar stability after interspinous and degenerative lumbar spondylolisthesis by retrospectively analyzing patients’ imaging data.
METHODS: A total of 108 patients with L4-5 lumbar spondylolisthesis in Department of Spinal Surgery, Tianjin People’s Hospital from December 2016 to January 2018 were analyzed retrospectively. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into non-effusion group (n=55) and effusion group (n=53) according to the presence and absence of intra-articular effusion of intervertebral facet joint based on lumbar MRI. The two groups were comparatively analyzed. In the effusion group, the correlation between the effusion width of bilateral facet joint and the dynamic slip index of sagittal vertebra, the rotation degree of sagittal vertebral body, bilateral degeneration index of facet joint, intervertebral disc degeneration index were statistically analyzed separately.
RESULTS AND CONCLUSION: (1) Compared with the effusion group, the instability rate was lower; the dynamic slip volume, dynamic slip index, and the sagittal rotation degree were less; and the degeneration degree of facet joint and intervertebral disc was higher in the non-effusion group (P=0.000). (2) There was a linear positive correlation between the width of effusion of bilateral facet joints and the dynamic slip index of the sagittal vertebral body, the rotation degree of the sagittal vertebral body in the effusion group (r=0.710, P=0.000; r=0.452, P=0.001). There was a linear negative correlation between the width of effusion of bilateral facet joints and the degeneration index of bilateral facet joint and intervertebral disc in the effusion group (r=-0.630, P=0.000; r=-0.648, P=0.000). (3) The presence of effusion in the facet joint on MRI in degenerative lumbar spondylolisthesis patients suggested instability. The total fluid accumulation of the facet joint in the segment of spondylolisthesis was positively correlated with the translation instability and rotation instability of the lumbar vertebrae. There was a negative correlation between the volume of effusion of bilateral facet joints and the degree of degeneration of intervertebral disc and facet joints.

Key words: facet joint effusion, lumbar MRI, lumbar spondylolisthesis, lumbar stability, intervertebral disc degeneration, correlation analysis

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