Lumbar facet joint motion in patients with degenerative disc disease at affected and adjacent levels: an in vivo biomechanical study.
Lumbar facet joint motion in patients with degenerative disc disease at affected and adjacent levels: an in vivo biomechanical study.
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DOI：
10.1097/brs.0b013e3181faaef7
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发表时间：
2011-05-01
期刊：
影响因子：
3
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Li W;Wang S;Xia Q;Passias P;Kozanek M;Wood K;Li G
对照实验室研究。评估腰椎间盘退行性疾病（DDD）对功能性负重活动期间小关节运动的影响。有研究表明，DDD对小关节的生物力学行为有不利影响。反过来，小关节运动改变被认为与各种类型的腰椎病理学相关，包括小关节退变、神经撞击和DDD进展。然而，迄今为止，没有数据报告的活动模式，腰椎小关节的DDD患者。研究了10例L4-S1 DDD症状患者。每个参与者都进行了磁共振成像，以获得腰椎（L2-S1）的三维模型和双透视成像在三个特征性的躯干运动：左右扭转，左右弯曲和屈曲伸展。通过将椎骨的三维模型与其在荧光透视图像上的轮廓相匹配来再现椎骨的体内位置。将小关节的运动学和运动范围（ROM）与先前研究中报告的一组健康参与者进行比较。DDD患者的小关节无优势旋转轴，不同节段的ROM无差异。在左右扭转时，DDD患者和健康参与者之间的ROM相似。在左右弯曲时，DDD患者的L4-L5绕中外侧轴的旋转显著大于健康受试者。在屈曲-伸展运动中，DDD患者L4-L5节段绕前后轴旋转和相邻节段绕前后轴旋转（L3-L4）也显著大于健康者，而DDD患者L2-L3和L3-L4节段绕内外轴旋转均显著小于健康者。DDD改变了小关节的ROM。旋转可以显着增加，不仅在DDD水平，而且在其相邻的水平相比，健康的参与者。旋转的增加并没有发生在躯干运动的主旋转轴周围，而是发生在耦合轴周围。这种在耦合旋转中的超活动性可能意味着与DDD相关的生物力学机制。
Controlled laboratory study. To evaluate the effect of lumbar degenerative disc diseases (DDDs) on motion of the facet joints during functional weight-bearing activities. It has been suggested that DDD adversely affects the biomechanical behavior of the facet joints. Altered facet joint motion, in turn, has been thought to associate with various types of lumbar spine pathology including facet degeneration, neural impingement, and DDD progression. However, to date, no data have been reported on the motion patterns of the lumbar facet joint in DDD patients. Ten symptomatic patients of DDD at L4–S1 were studied. Each participant underwent magnetic resonance images to obtain three-dimensional models of the lumbar vertebrae (L2–S1) and dual fluoroscopic imaging during three characteristic trunk motions: left-right torsion, left-right bending, and flexion-extension. In vivo positions of the vertebrae were reproduced by matching the three-dimensional models of the vertebrae to their outlines on the fluoroscopic images. The kinematics of the facet joints and the ranges of motion (ROMs) were compared with a group of healthy participants reported in a previous study. In facet joints of the DDD patients, there was no predominant axis of rotation and no difference in ROMs was found between the different levels. During left-right torsion, the ROMs were similar between the DDD patients and the healthy participants. During left-right bending, the rotation around mediolateral axis at L4–L5, in the DDD patients, was significantly larger than that of the healthy participants. During flexion-extension, the rotations around anterioposterior axis at L4–L5 and around craniocaudal axis at the adjacent level (L3–L4), in the DDD patients, were also significantly larger, whereas the rotation around mediolateral axis at both L2–L3 and L3–L4 levels in the DDD patients were significantly smaller than those of the healthy participants. DDD alters the ROMs of the facet joints. The rotations can increase significantly not only at the DDD levels but also at their adjacent levels when compared to those of the healthy participants. The increase in rotations did not occur around the primary rotation axis of the torso motion but around the coupled axes. This hypermobility in coupled rotations might imply a biomechanical mechanism related to DDD.