老年腰椎小关节骨性关节炎软骨退变病理与影像学改变相关性研究

摘要

目的：探究老年腰椎小关节骨性关节炎软骨退变病理与影像学改变的相关性，为临床疾病的诊断提供参考。方法选取我院2012年6月至2015年5月收治的腰椎管狭窄或腰椎间盘突出并接受椎间孔入路椎体间融合术治疗的老年患者56例，术前给予腰椎CT和MRI检查，术中取小关节软骨检测病理。Weishaup和Borden标准对影像结果进行分级，Nicola标准对软骨病理进行分级。Spearman法分析影像学改变与病理相关性。结果责任腰椎主要为L4~5，CT和MRI对0~1级软骨退变检测准确率分别为44.12%和47.06%，而对2~3级退变检测准确率分别为91.49%和89.36%。与0~1级病变比较，CT和MRI对3~4级病变检测准确率显著升高(P<0.05)。MRI不对称程度对1~2级软骨退变检测准确率为41.18%，显著低于对3~4级退变检测准确率(89.36%)。CT和MRI Weishaup分级与2~3级腰椎退变病理显著相关(P<0.05)。结论2~3级关节炎软骨退变与CT、MRI影像学改变呈显著正相关性，对0~1级病变的临床诊断存在局限性。%Objective To explore the correlation between pathology of cartilage degeneration in the elderly pa-tients with lumbar facet joint osteoarthritis and imageological change, in order to provide some reference for the diagno-sis of clinical diseases. Methods Fifty-six elderly patients with lumbar spinal stenosis or lumbar disc herniation and treated with transforaminal lumbar interbody fusion (TLIF) were selected from June 2012 to May 2015. Both computed tomography (CT) and magnetic resonance imaging (MRI) examination were given before TLIF operation, and the carti-lage tissues were selected in the operation for pathological examination. Weishaup and Borden were used to grade the imageological results, and Nicola were employed to grade the pathological changes. Correlation between pathology of cartilage degeneration and imageological changes was analyzed by Spearman method. Results The main lumbar spine were L4~5. CT and MRI had low accuracy rate to detect grade 0~1 cartilage degeneration of lumbar facet joint osteoarthri-tis with 44.12%and 47.06%, but had high accuracy rate to detect grade 2~3 cartilage degeneration in lumbar facet joint osteoarthritis with 91.49%and 89.36%. Compared with grade 0~1, the accuracy rate of CT and MRI were significantly higher for grade 3~4 (P<0.05). The detection accuracy rate of MRI asymmetry degree for grade 1~2 cartilage degenera-tion was significantly lower than that of grade 3~4 (41.18%vs 89.36%, P<0.05). There was significant correlation be-tween the CT and MRI Weishaup classification and grade 2~3pathology of cartilage degeneration in lumbar facet joint osteoarthritis (P<0.05). Conclusion There is significant correlations between grade 3~4 cartilage degeneration in lum-bar facet joint osteoarthritis and imageological change of CT and MRI, and there were limitations in the clinical diagno-sis for 1~2 grade.