腰痛患者腰椎小关节退变与椎间盘退变的MRI比较

摘要

背景：研究脊柱退变的过程时发现椎间盘与小关节相互关联同时也相互影响，并将影响脊柱的正常功能及稳定，从而引起腰痛，而关于椎间盘和小关节的退变顺序一直存在争议。目的：分析腰痛患者中腰椎小关节退变与椎间盘退变之间的关系。方法：回顾性分析186例腰痛患者的腰椎MRI，对每例患者的L2-S1四个运动节段的小关节及椎间盘的退变进行评估。按年龄将入选人群分为3组(<40岁，40-60岁，>60岁)。结果与结论：腰椎小关节及椎间盘退变比率均随年龄增长而增加，二者退变均在L4-5、L5-S1节段退变最明显。在小关节与椎间盘的退变比率比较中，在各年龄段的各节段中椎间盘退变比率均大于小关节退变比率，除了年龄<40岁及40-60岁的抽样人群中L2-3小关节退变多于椎间盘退变，但差异无显著性意义(P>0.05)。腰椎小关节退变与椎间盘退变之间的相关性呈弱相关(χ2=100.9，P <0.001，gamma=0.22)。结果提示椎间盘退变与小关节退变均随年龄增长而增加，二种退变间呈弱相关，而二者在腰椎退变中的退变顺序仍不明确，需进一步研究。%BACKGROUND:During spinal degeneration process, the intervertebral disc and facet joints are interrelated and interacted to impact the normal function and stability of the spine, thereby resulting in low back pain. Moreover, there is always a controversy on the degeneration order of the intervertebral disc and facet joint. OBJECTIVE:To explore the relationship between lumbar facet joint degeneration and intervertebral disc degeneration in patients with low back pain. METHODS: A retrospective analysis was made on the clinical data of 186 patients with low back pain. The facet joint degeneration and intervertebral disc degeneration at L2-S1 motion segments of each patient were evaluated. Enroled patients were divided into three age groups: < 40 years old, 40-60 years old and≥ 60 years old. RESULTS AND CONCLUSION:The incidence of lumbar facet joint and intervertebral disc degeneration was increased with age, and degeneration of the lumbar facet joint and intervertebral disc were the most obvious at L4-5 and L5-S1 segments. The incidence of intervertebral disc degeneration was more than that of facet joint degeneration at each segment in al age groups, except groups of < 40 years old and 40-60 years old at L2-3 segments, but there was no significant difference (P > 0.05). There was a weak correlation between facet joint degeneration and intervertebral disc degeneration (χ2=100.9,P < 0.001, gamma=0.22). These findings show that the incidence of intervertebral disc degeneration and facet joint degeneration is increased with age, and there is a weak correlation between them. However, the lumbar degenerative order is stil unclear and further research is needed.