Rapała Kazimierz, Chaberek Sławomir, Truszczyńska Aleksandra, Lukawski Stanisław, Walczak Piotr
Professor Adam Gruca Teaching Hospital, Otwock, Poland.
Ortop Traumatol Rehabil. 2009 May-Jun;11(3):222-32.
Publications concerning the shape of the spinal canal and degenerative changes in the intervertebral joints have not described this issue in full detail to date, especially with regard to the causes of pain syndromes associated with degenerative changes in intervertebral joints. The aim of the study was to assess the shape of the spinal canal and joint surface angles at L3, L4 and L5.
The study involved 176 patients with clinical and radiological evidence of spinal canal stenosis confirmed by computed tomography.
Morphometric measurements were conducted to a precision of 0.01 degrees . At the level of L4-L5, a triangular spinal canal was found in 66 patients, and a trefoil spinal canal in 71. The results demonstrate that, in the group of 176 patients with spinal canal stenosis, mean differences between right and left angles were 11.37 degrees at the L3 level, 9.40 degrees at the L4 level, and 11.57 degrees at the L5 level. In the control group, mean differences were 2.15 degrees at the L3 level, 2.26 degrees at the L4 level, and 2.98 degrees at the L5 level. Statistically significant differences between the groups were found for p= 0.05 at each level (L3, L4, L5). The level of significance of angular differences at these levels warrants the conclusion that there is joint incongruence that may give rise to degenerative changes.
While the most common pathomechanism underlying degenerative changes is vertebral sinking in the course of disc disease and emerging intervertebral instability, abnormal intervertebral angles can also lead to instability that gives rise to degenerative changes.
迄今为止，关于椎管形状以及椎间关节退变改变的相关出版物尚未全面详细地描述这一问题，尤其是与椎间关节退变改变相关的疼痛综合征的病因。本研究的目的是评估L3、L4和L5水平的椎管形状及关节面角度。
本研究纳入了176例经计算机断层扫描证实有椎管狭窄临床和影像学证据的患者。
形态学测量精确到0.01度。在L4-L5水平，66例患者发现椎管呈三角形，71例呈三叶形。结果表明，在176例椎管狭窄患者组中，L3水平左右角度的平均差异为11.37度，L4水平为9.40度，L5水平为11.57度。在对照组中，L3水平平均差异为2.15度，L4水平为2.26度，L5水平为2.98度。各水平（L3、L4、L5）组间差异在p = 0.05时有统计学意义。这些水平角度差异的显著性程度足以得出结论，即存在关节不协调，这可能导致退变改变。
虽然退变改变最常见的病理机制是椎间盘疾病过程中椎体下沉及出现椎间不稳定，但异常的椎间角度也可导致不稳定，进而引起退变改变。
