Karacan Ilhan, Aydin Teoman, Sahin Zerrin, Cidem Muharrem, Koyuncu Halil, Aktas Ilknur, Uludag Murat
Department of Physical Medicine & Rehabilitation, SSK Vakif Gureba Hospital, Istanbul, Turkey.
Spine (Phila Pa 1976). 2004 May 15;29(10):1132-6. doi: 10.1097/00007632-200405150-00016.
STUDY DESIGN: Cross-sectional study. OBJECTIVE: To investigate the alteration of facet joint angle and its relation to anthropometric features in lumbar disc herniation. SUMMARY OF BACKGROUND DATA: In the previous studies, the facet tropism and its relation to the level, type, side, and development of lumbar disc herniation were reported. This study was the first to correlate anthropometric feature, facet angle, and asymmetry in patients with lumbar disc herniation. METHODS.: Sixty-one patients with lumbar disc herniation were included in this study. The body height, vertex-to-spina iliaca posterior superior distance, spina iliaca posterior superior-to-floor distance, and net weight were measured and body mass index calculated. The facet angles were measured for each facet joint using computed tomography. The intraobserver error was found to be +/- 1.66 degrees. We defined facet tropism as the bilateral angle difference greater than 2 intraobserver errors. The asymmetry rate was a ratio of degree of angles of the more coronally oriented facet joint to the more sagittally oriented facet joint at the same intervertebral level. RESULTS: The facet asymmetry was observed at the herniation level in 70.5% of the patients. There was a correlation between the degree of the more sagittally oriented facet joint angle and facet asymmetry rate at the herniation level (R = -0.684, P = 0.0001 for L4-L5 lumbar disc herniation; R = -0.509, P = 0.008 for L5-S1 lumbar disc herniation). The body height correlated with the degree of the more sagittally oriented facet joint angle, the degree of more coronally oriented facet joint angle, and asymmetry rate, respectively (R = -0.571, P = 0.0001; R = -0.474, P = 0.002; R = 0.314, P = 0.045, respectively). There was no correlation between the degree of these angles and the vertex-to-spina iliaca posterior superior distance. The spina iliaca posterior superior-to-floor distance was correlated with the degree of the more sagittally oriented facet joint angle (R = -0.457, P = 0.0001) and more coronally oriented facet joint angle (R = -0.435, P = 0.004) but not with the asymmetry rate. The degree of facet angles was not correlated with body weight and body mass index. CONCLUSION: This study revealed that patients with lumbar disc herniation had the asymmetry and sagittalization of facet joints, and these alterations were more evident in the taller patients.
研究设计：横断面研究。 目的：探讨腰椎间盘突出症患者小关节角度的改变及其与人体测量学特征的关系。 背景数据总结：在以往的研究中，已报道了腰椎小关节的不对称性及其与腰椎间盘突出症的节段、类型、侧别和发展的关系。本研究首次将腰椎间盘突出症患者的人体测量学特征、小关节角度和不对称性进行关联。 方法：本研究纳入了61例腰椎间盘突出症患者。测量身高、头顶至髂后上棘距离、髂后上棘至地面距离和净重，并计算体重指数。使用计算机断层扫描测量每个小关节的小关节角度。观察者内误差为±1.66度。我们将小关节不对称定义为双侧角度差大于2个观察者内误差。不对称率是同一椎间水平上更偏向冠状位的小关节角度与更偏向矢状位的小关节角度的度数之比。 结果：70.5%的患者在突出节段观察到小关节不对称。在突出节段，更偏向矢状位的小关节角度度数与小关节不对称率之间存在相关性（L4-L5腰椎间盘突出症：R = -0.684，P = 0.0001；L5-S1腰椎间盘突出症：R = -0.509，P = 0.008）。身高分别与更偏向矢状位的小关节角度度数、更偏向冠状位的小关节角度度数和不对称率相关（分别为R = -0.571，P = 0.0001；R = -0.474，P = 0.002；R = 0.314，P = 0.045）。这些角度的度数与头顶至髂后上棘距离之间无相关性。髂后上棘至地面距离与更偏向矢状位的小关节角度度数（R = -0.457，P = 0.0001）和更偏向冠状位的小关节角度度数（R = -0.435，P = 0.004）相关，但与不对称率无关。小关节角度的度数与体重和体重指数无关。 结论：本研究表明，腰椎间盘突出症患者存在小关节不对称和矢状化，且这些改变在较高的患者中更为明显。
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