Lumbar facet joint motion in patients with degenerative spondylolisthesis.
Lumbar facet joint motion in patients with degenerative spondylolisthesis.
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DOI：
10.1097/bsd.0b013e31827a254f
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发表时间：
2013-02
影响因子：
--
通讯作者：
Wood KB
中科院分区：
文献类型：
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作者：
Yao Q;Wang S;Shin JH;Li G;Wood KB
对照实验室研究。目的探讨退行性腰椎滑脱(DLS)在不同功能负重活动过程中对小关节运动的生物力学影响。虽然少数研究报道了DLS患者小关节的形态变化，但关于这些小关节的运动学数据尚未见报道。对10例L4~L5的DLS患者进行了研究。每个患者都接受了磁共振成像(MRI)扫描，从L2-L5获得腰椎的三维(3D)模型，并在不同姿势下进行双透视成像扫描：屈伸、左右弯曲和左右扭转。通过将基于MRI的椎体模型与透视图像进行匹配来再现椎骨的位置。将小关节的运动学和活动范围(ROMs)与健康人和退行性间盘疾病(DDD)患者的运动学和运动范围进行比较。在DLS患者中，小关节在DLS节段(L4~L5)的旋转范围明显小于相邻节段(L2~L3和L3~L4)，而所有节段的平移范围相似。与相应椎体水平(L4~L5)的DDD患者和健康受试者相比，DLS节段小关节的旋转范围减小，但平移范围无明显差异。DLS和DDD患者的小关节活动度在相邻节段(L2~L3和L3~L4)上相似。与健康受试者和DDD患者相比，患者在DLS节段(L4-L5)的小关节旋转范围减小。旋转范围的减少意味着DLS病可能导致关节重新稳定。这些数据有助于选择DLS患者的保守治疗或不同的手术方法。
Controlled laboratory study. To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Although the morphological changes of the facet joints in patients with DLS have been reported in a few studies, no data has been reported on the kinematics of these facet joints. Ten patients with DLS at L4–L5 were studied. Each patient underwent a magnetic resonance imaging (MRI) scan to obtain three-dimensional (3D) models of the lumbar vertebrae from L2–L5 as well as a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending and left-right torsion. The positions of the vertebrae were reproduced by matching the MRI-based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion (ROMs) were compared with those of healthy subjects and those of patients with degenerative disc diseases (DDD) previously published. In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4–L5) than that at the adjacent levels (L2–L3 and L3–L4), while the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared to those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4–L5), while no significant difference was found in the range of translation. The ROM of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2–L3 and L3–L4). The range of rotation decreased at the facet joints at the DLS level (L4–L5) in patients compared to those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different surgical techniques for the DLS patients.