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腰椎间盘突出症与腰椎椎管狭窄症患者的关节突关节差异
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Abstract:
目的：测量腰椎病变节段椎体和关节突关节的直径，计算两者的比值并在腰椎间盘突出症(LDH)和腰椎椎管狭窄症(LSS)患者之间进行比较。研究背景：有很多研究表明，腰椎的负荷是由椎体和后方的关节突关节共同负担，作为后方的主要承载体，关节突关节大小、方向势必会影响其负重，进而影响某些疾病的发生。方法：214名仅在L4~L5或L5/S1水平的LDH患者被分到1组，80名LSS患者被分到第2组。同时考虑到男女性结构差异，在各组内按照性别又分为男性组和女性组，分别针对CT影像上L4/5、L5/S1水平的椎体直径和关节突关节直径进行了两次测量，取其平均值。结果：我们发现在L4/5、L5/S1突出与狭窄患者中，LSS患者的关节突关节直径以及比例均小于LDH患者，且LSS患者直腿抬高试验阳性率也是低于LDH患者。结论：在这项研究中，关节突关节作为脊柱后方的主要承重结构，其结构的差异影响腰椎活动中的力量分布，关节突关节直径小者更容易发生LSS，LDH患者的关节突关节较之LSS更大。
Objective: To measure the diameter of the vertebral body and facet joints in the lumbar lesion seg-ment, calculate the ratio of the two, and compare them between patients with lumbar disc herni-ation (LDH) and lumbar spinal stenosis (LSS). Research Background: Many studies have shown that the load on the lumbar spine is jointly borne by the vertebral body and the posterior articular pro-cess joints. As the main load-bearing body in the posterior region, the size and direction of the ar-ticular process joints will inevitably affect their load, thereby affecting the occurrence of certain diseases. Method: 214 LDH patients with only L4-L5 or L5/S1 levels were assigned to Group 1, and 80 LSS patients were assigned to Group 2. Considering the structural differences between males and females, each group was further divided into male and female groups based on gender. Two meas-urements were taken on the vertebral body diameter and articular process joint diameter at the L4/5 and L5/S1 levels on CT images, and the average value was taken. Result: We found that in pa-tients with L4/5 and L5/S1 protrusion and stenosis, the joint diameter and proportion of LSS pa-tients were smaller than those of LDH patients, and the positive rate of straight leg elevation test in LSS patients was also lower than that in LDH patients. Conclusion: In this study, the articular pro-cess joints were found to be the main load-bearing structure behind the spine, and their structural differences affected the distribution of force during lumbar spine activity. Patients with smaller ar-ticular process joint diameters were more prone to LSS, while patients with LDH had larger articular process joints compared to LSS.
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