L4/5、L5/S1 关节突关节不同平面及头尾端不对称性与椎间 盘突出的相关性研究

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题名	L4/5、L5/S1 关节突关节不同平面及头尾端不对称性与椎间盘突出的相关性研究
其他题名	Lumbar facet tropism on different facet portions and asymmetry between ipsilateral cephalad and caudad portions: their correlations with lumbar disc herniation
作者	李道友
学位类型	硕士
导师	滕红林
答辩日期	2020-05-23
学位授予单位	温州医科大学
学位专业	外科学（骨外科）
关键词	腰椎间盘突出症关节突不对称性关节突头端关节突尾端 CT
摘要	目的：通过 CT 横断面测量 L4/5、L5/S1 双侧关节突关节面朝向角度，研究双侧关节突关节面角度分别在头尾端平面不对称性（Facet Tropism，FT），以及同侧关节突关节头、尾端角度不对称性与与腰椎间盘突出（Lumbar Disc Herniation， LDH）的相关性。为进一步深入理解腰椎关节突关节退变与椎间盘退变的相互作用以及腰椎退变性疾病的发病机制提供依据。研究背景：腰椎椎间盘和双侧关节突关节是维持腰椎动态和静态稳定性的重要结构。两者在腰椎退变过程中的相互作用已受到广泛研究关注，尤其是 LDH 与腰椎双侧关节突关节 FT 的相关性。然而，可能由于不同研究在病例选取和对腰椎 FT 定义上的偏差，至今对 LDH 和关节突关节 FT 的确切相关性仍存在争议。既往有研究显示腰椎退变滑脱的关节面头尾端朝向角度存在差异，而这种差异亦可能存在于 LDH 患者中，且对 FT 的测定以及 LDH 和 FT 相关性的研究结果产生影响。方法：收集 2016 年 1 月至 2018 年 12 月温州医科大学附属第一医院脊柱外科诊治的共计 723 例诊断为腰椎间盘突出症的患者，经纳入、排除标准筛选后，通过年龄和性别匹配分别选取影像资料符合测量要求的 100 例 L4/5 腰椎间盘突出患者、100 例 L5/S1 腰椎间盘突出患者和 100 例非腰椎间盘突出患者（对照组）纳入本研究。每组受试者按年龄分为两组（年龄≥50 岁或＜50 岁）。在 CT 横断面上分别测量 L4/5 LDH 组中的 L4/5 节段、L5/S1 LDH 组中的 L5/S1 节段和对照组中 L4/5、L5/S1 节段的双侧关节突关节面在头、尾端的朝向角度，计算各组左右关节突关节角度差值的平均值和 FT 的比例（包括关节突关节的头、尾端）以及同侧关节突关节头、尾端角度差值的平均值和头尾端不对称的比例。运用 SPSS 24.0 软件进行统计分析，分别比较 L4/5 和 L5/S1 LDH 组与对照组头尾端双侧关节面角度差异的平均值和 FT 比例，同侧关节面头尾端角度差异的平均值和不对称比例。结果：（1）与对照组相比，L4/5 LDH 组头端关节面角度大于尾端关节面角度，但无统计学差异（P＞0.05）。（2）高龄（≥50 岁）L4/5 LDH 患者的双侧关节面 2 温州医科大学硕士学位论文角度差异平均值在头、尾端均显著大于对照组（头端 P＜0.001，尾端 P=0.026）。而低龄（＜50 岁）L4/5 突出组和 L5/S1 组与相应对照组相比，双侧关节面角度差异平均值无统计学差异。（3）关节面 FT 的发生率方面，高龄 L4/5 LDH 组在关节面头端显著高于相应对照组（P=0.004），而尾端平面则无统计学差异。而其余 LDH 组无论在关节面头端和尾端，与对照组相比均无统计学差异。（4）在关节面同侧头尾端角度差异平均值方面，高龄 L4/5 LDH 患者组显著高于相应对照组（左侧 P=0.001,右侧 P=0.015），而其余 LDH 组与对照组相比均无统计学差异。（5）在关节面同侧头尾端角度不对称发生率方面，高龄 L4/5 LDH 患者组显著高于相应对照组（左侧 P=0.004,右侧 P=0.027），而其余 LDH 组与对照组相比均无统计学差异。结论：关节突关节面头端而不是尾端的 FT 与高龄患者（年龄≥50 岁）的 L4/5 LDH 具有相关性，而在低龄 L4/5 LDH 组或 L5/S1 LDH 患者中，FT 和 LDH 则不存在相关性。在不同横断位平面上测量关节突关节角度会导致 FT 统计上的偏差。关节突关节面同侧头、尾端角度的不对称性也只在高龄 L4/5LDH 患者中与 LDH 存在相关性，低龄或 L5/S1 LDH 患者中，关节面同侧头、尾端角度不对称性与 LDH 无相关性。
其他摘要	Objective: To investigate the correlation between lumbar disc herniation (LDH) and lumbar facet tropism (FT) on cephalad and caudad facet portions, respectively; to investigate the asymmetry between ipsilateral cephalad and caudad facet portions and its correlation with LDH. To provide an in-depth understanding of the interaction between disc and facet joint degeneration and the pathogenesis of lumbar degenerative diseases Research background: Lumbar intervertebral discs and bilateral articular processes are important structures for maintaining the dynamic and static stability of the lumbar spine. The interaction between the two in the process of lumbar spine degeneration has generally received extensive research, especially the correlation between LDH and bilateral lumbar FT. However, the exact correlation between LDH and lumbar FT may still be controversial due to the bias of case selection and definition of lumbar FT in different studies. Previous studies have shown that there is a difference in the cephalad-cuadad orientation of the articular surface of the lumbar degenerative spondylolisthesis, and this difference may also exist in patients with LDH, and it has an impact on the measurement of FT and the results of LDH and FT correlation studies. Methods: A total of 723 patients were treated in the department of spinal surgery of the First Affiliated Hospital of Wenzhou Medical University from Jan. 2016 to Dec. 2018. The main clinical diagnosis was single-segment lumbar disc herniation. After screening by inclusion and exclusion criteria, one hundred patients with L4/5 LDH, 100 patients with L5/S1 LDH and 100 participants without LDH (control group) were age and gender-matched and included in this study. Participants in each group were further divided into two subgroups based on age (≥ or < 50 years old). Bilateral facet joint angles of L4/5 in L4/5 LDH group, facet angles of L5/S1 in L5/S1 LDH 4 温州医科大学硕士学位论文 group and facet angles of L4/5 and L5/S1 in control group were measured on axial plane of CT scan. All statistical analysis and calculations were performed using SPSS 24.0. FT and asymmetry between ipsilateral cephalad and caudad portions in each LDH group were compared with those in the corresponding control group. Results: (1) The results showed that facet angles of cephalad portion were larger (more sagittally oriented) than that of caudad portion in L4/5 measurement groups. However, there was no significant difference (P≥ 0.05) between the facet angles of cephalad and caudad portions in all groups. (2) The mean difference of facet angles between left and right sides of older patients (≥ 50 years old) with L4/5 LDH was significantly greater than that of control participants either on cephalad portion (P＜ 0.001) or caudad portion (P=0.026) of facet joint. The mean facet angles differences of younger patients (< 50 years old) with L4/5 LDH and patients with L5/S1 LDH were not significantly different (P≥ 0.05) from those of control participants. (3) Comparing with control participants, older patients (≥50 years old) with L4/5 LDH exhibited significantly higher frequency of FT only on the cephalad portion (P=0.004) but not the caudad portion of the facet joint. The mean facet angles differences of younger patients (< 50 years old) with L4/5 LDH and patients with L5/S1 LDH were not significantly different (P≥0.05) from those of control participants. (4) The mean delta facet angle of older patients (≥50 years old) with L4/5 LDH was significantly greater than that of control participants either on left side (P =0.001) and right side (P= 0.015), and there was no significant difference between other LDH group with the control group. (5) Comparing with control participants, older patients (≥50 years old) with L4/5 LDH exhibited significantly higher frequency of asymmetry between ipsilateral cephalad and caudad portions either on left side ( P= 0.004) and right side ( P= 0.027). Conclusions: Only the FT on cephalad portion but not caudad portion of facet joint is associated with L4/5 LDH of older patients. There was no correlation between FT and LDH in younger patients (< 50 years old) with L4/5 LDH or patients with L5/S1 LDH. The measurement on different portions of facet joint may result in discrepancy on FT identification. Asymmetry between ipsilateral cephalad and caudad facet portions is also associated with L4/5 LDH in older patients. The asymmetry between ipsilateral cephalad and caudad facet portions in younger patients (< 50 years old) with L4/5 5 温州医科大学硕士学位论文 LDH or patients with L5/S1 LDH were not significantly different (P≥ 0.05) from those in control participants.
学号	171001234
发布年限	2020-05-23
毕业论文分类号	R6
原始专题	第一临床医学院、信息与工程学院
全文文件名	171001234李道友2020外科学.pdf
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/179679
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、信息与工程学院
第一作者单位	温州医科大学
推荐引用方式 GB/T 7714	李道友. L4/5、L5/S1 关节突关节不同平面及头尾端不对称性与椎间盘突出的相关性研究[D]. 温州医科大学,2020.