颈椎关节突关节的不对称性与颈椎间盘突出的相关性研究

科研成果详情

题名	颈椎关节突关节的不对称性与颈椎间盘突出的相关性研究
其他题名	The correlation between tropism of facet joints and cervical intervertebral disc herniation in the subaxial cervical spine
作者	陈国梁
学位类型	硕士
导师	滕红林
答辩日期	2021-06-04
学位授予单位	温州医科大学
学位专业	外科学
关键词	关节突不对称性关节突角度颈椎间盘突出椎间盘退变下颈椎 CT MRI
摘要	目的：通过CT的横断面，矢状面和冠状面测量颈椎关节突关节面的朝向角度，研究双侧关节突关节面角度的不对称性（Facet Tropism，FT）与颈椎间盘突出（Cervical Disc Herniation，CDH）之间的相关性。这将有助于理解颈椎关节突关节与椎间盘退变之间的机理，为预测颈椎退行性椎疾病的进展或预后，以及进一步手术决策提供依据。研究背景：椎间盘和双侧关节突关节是维持脊柱静态和动态稳定性的主要结构，因此椎间盘和小关节的退变或特定变化被认为是进行性脊柱退行性疾病的重要病理基础。先前文献报道腰椎间盘的退变可加块关节突关节的退变和导致骨关节炎的发生，也有研究显示腰椎双侧关节突关节FT与腰椎间盘退变或椎间盘突出相关。但是目前颈椎双侧关节突关节FT和CDH之间的相关性仍不清楚。方法：收集2009年1月至2019年6月间在我院脊柱外科诊断为CDH并接受手术的患者，经纳入和排除标准进行筛查后，选取了一共200例单节段CDH患者，C3 / 4（男27例，女23例，38-82岁，平均年龄58.7岁），C4 / 5（男28例，女22例，33-77岁，平均年龄56.9岁），C5 / 6（男26例，女24例，35-75岁，平均年龄56.3岁）以及C6 / 7（男29例，女21例，36-74岁，平均年龄57.8岁）每个层面各50例。另外纳入50个年龄性别相匹配（男28例，女22例，36-78岁，平均年龄为54.5岁）的无CDH的正常人作为“正常对照组”。在CDH患者中，颈椎发生CDH的层面和无CDH的层面分别又被细分为 “病例组” 和 “病例对照组”。对于所有受试者，分别在CT图像的横断面，矢状面和冠状面上测量C3 / 4，C4 / 5，C5 / 6和C6 / 7的双侧关节突关节的朝向角度，计算各组双侧关节突关节角度差值的平均值与标准差，并将FT定义为同一层面的双侧关节突关节角度之差 ≥ 平均值 + 标准差，比较各组双侧关节突关节角度之间的平均差异和FT的发生率。记录每个CDH患者的椎间盘突出位置（左侧，中央或右侧），并相应地记录突出节段在CT各轴面上较大的关节突关节角度位置（左侧或右侧）。在颈椎MRI上评估并记录每个节段的椎间盘退变程度。所有统计分析和计算均在SPSS 25.0版本上执行。结果：无论是在C3 / 4，C4 / 5，C5 / 6或C6 / 7节段中，还是在横断面，矢状面或冠状面上，病例组双侧关节突关节角度之间的平均差异以及FT的发生率均显著大于两个对照组（P <0.001）。在大多数的病例对照组中，双侧关节突关节角度之间的平均差异以及FT的发生率并不显著大于相应的正常对照组（P > 0.05）。无论在横断面，矢状面或冠状面上，椎间盘突出的位置与左侧或右侧更大的关节突关节角度比例均无显著相关性（P > 0.05）。在颈椎各节段上，病例组与病例对照组之间的椎间盘退变的程度无显著差异（P > 0.05），但病例组和病例对照组的平均椎间盘退变程度均明显高于正常对照组（P <0.001）。结论：在横断面，矢状面和冠状面上的双侧关节突关节角度差异和FT都与CDH（C3 / 4，C4 / 5，C5 / 6和C6 / 7）显著相关，CDH患者比正常人存在更多的颈椎关节突关节不对称性的情况。左侧或右侧的较大关节突关节角度不会影响到椎间盘突出的方位，更大的关节突关节角度的分布方位似乎是随机的。颈椎间盘突出与FT相关，但颈椎间盘退变的严重程度与FT无关，这可能提示椎间盘退变后向CDH发展的后续病理变化和异常应力改变等可能与FT的形成有关。
其他摘要	Objective: To investigate the correlation between the facet tropism (FT) and cervical disc herniation (CDH) in the subaxial spine. To identify the exact correlation between FT and CDH is beneficial for not only understanding the mechanism of spinal degeneration, but also predicting the progression or prognosis of degenerative disc disease and further aiding the surgical decision. Research background: Intervertebral disc and bilateral facet joints are the major structures for maintaining static and dynamic stability of spinal column. The degeneration or specific changes of disc and facet joints are considered as the important pathological basis for advanced degenerative spinal diseases. It has been reported that lumbar disc degeneration can aggravate facet joints degeneration and osteoarthritis. On the other hand, the facet tropism (FT) which is defined as an asymmetry between the left and right facet joint orientations was also widely reported to correlate with disc degeneration or herniation in the lumbar spine. However, the exact correlation between FT and cervical disc herniation (CDH) is still unclear. Methods: We collected the data of patients diagnosed with single-segment CDH and who have undergone surgery in our hospital from January 2009 to June 2019. After screening by inclusion and exclusion criteria, a total of 200 patients with single-segment CDH: C3/4 ( 27 males, 23 females, an age range of 38-82 years old and an average age of 58.7 years), C4/5 (28 males, 22 females, an age range of 33-77 years old and an average age of 56.9 years), C5/6 (26 males, 24 females, an age range of 35-75 years old and an average age of 56.3 years old) and C6/7 (29 males, 21 females, an age range of 36-74 years old and an average age of 57.8 years), 50 cases for each segment. In addition, 50 age and gender-matched (28 males and 22 females, age range of 36-78 years old, with an average age of 54.5 years) without CDH were included as the "normal control group". In CDH patients, the level where CDH occurs and the level without CDH in the cervical spine are subdivided into "patient group" and "patient-control group" respectively. Bilateral facet angles of C3/4, C4/5, C5/6 and C6/7 were measured on axial, sagittal and coronal planes of CT images respectively for all participants. For defining tropism on each CT plane, the mean and SD of the differences between left and right facet angles at each cervical level was calculated, and the tropism was defined as the difference between left and right facet angles ≥ mean + SD . The FT was compared among herniation group and two control groups based on the mean difference between bilateral facet angles and the incidence of tropism in each group. The side of herniation (left or central or right) in each CDH case was recorded, and the side of greater facet angle (left or right) in each herniated level on each CT plane was also identified accordingly. The disc degeneration at each level was asse ssed on MRI. All statistical analysis and calculations were performed using SPSS 25.0. Results: Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6 or C6/7 level and whenever on sagittal, axial or coronal plane (P < 0.001). The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups (P > 0.05). The proportion between the left and right side of greater facet angle was not significantly different (P > 0.05) among the left, central and right herniation groups, whenever on sagittal, axial or coronal plane. There was no significant difference between herniation group and patient control group based on the mean disc degeneration grade with respect to all cervical levels (P > 0.05). The mean disc degeneration grades in both herniation groups and patient control groups were significantly higher than those in normal control groups with respect to all cervical levels (P < 0.001). Conclusions: The FT with respect to the sagittal, axial and coronal planes are all associated with CDH in subaxial cervical spine (C3/4, C4/5, C5/6 and C6/7), CDH patients in comparison with normal patients present with more cervical facet joint asymmetry. However, the greater facet angle at the left or right side does not affect the side of herniation. For greater facet joints, the angle distribution seems random. The severity of cervical disc degeneration is not associated with FT, this implies subsequent pathological changes and abnormal stress changes after disc degeneration leading to CDH may be related to FT formation.
学号	181001235
发布年限	2021-06-11
毕业论文分类号	0R0608
原始专题	第一临床医学院
学位论文研究方向	骨科学
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全文文件名	181001235陈国梁2021外科学.pdf\|181001235陈国梁2021外科学.doc
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/177798
专题	温州医科大学
作者单位	溫州医科大学第一临床医学院
第一作者单位	温州医科大学
推荐引用方式 GB/T 7714	陈国梁. 颈椎关节突关节的不对称性与颈椎间盘突出的相关性研究[D]. 温州医科大学,2021.