Mohanty Simanchal Prosad, Kanhangad Madhava Pai, Kamath Siddarth, Kamath Asha
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Asian Spine J. 2018 Oct;12(5):902-909. doi: 10.31616/asj.2018.12.5.902. Epub 2018 Sep 10.
Cross-sectional study.
To evaluate the association between zygapophyseal joint angle (ZJA), facet tropism (FT), and lumbar intervertebral disc prolapse (IVDP).
Several studies have shown that FT increases the risk of IVDP and have postulated that a more sagittally oriented zygapophyseal joint provides less mechanical resistance to axial torque, thereby exerting excessive rotational strain on the intervertebral disc, resulting in an annular tear. In contrast, other studies have found no definitive association between FT and IVDP. Therefore, conclusive evidence regarding the role of FT in the pathogenesis of disc prolapse is currently lacking.
Magnetic resonance imaging scans of 426 patients with single-level lumbar IVDP were analyzed. Right and left ZJAs of the lumbar segments were measured on axial sections. The frequency and severity of FT were determined by calculating the absolute difference between the right and left ZJAs. Patients without IVDP at L4-L5 and L5-S1 served as controls for those with IVDP at L4-L5 and L5-S1, respectively. Chi-square test and t -test were used to compare the severity and frequency of FT between patients with and without IVDP. The receiver operating characteristic analysis was performed to determine the critical FT values that were predictive of IVDP.
Patients with IVDP exhibited a higher frequency (L4-L5: 47% vs. 15.08%; L5-S1: 39.62% vs. 22.69%; p =0.001) and severity (L4-L5: 7.85°±3.5° vs. 4.05°±2.62°; L5-S1: 7.30°±3.07° vs. 4.82°±3.29°; p <0.001) of FT than those without IVDP. Critical FT values of 5.7° at L4-L5 and 6° at L5-S1 increased the likelihood of IVDP by a factor of 2.89 and 1.75, respectively.
Our results confirm the existence of a significant association between lumbar IVDP and FT; however, a causal relationship could not be ascertained.
横断面研究。
评估关节突关节角（ZJA）、小关节不对称（FT）与腰椎间盘突出症（IVDP）之间的关联。
多项研究表明，FT会增加IVDP的风险，并推测矢状位方向更明显的关节突关节对轴向扭矩的机械阻力较小，从而对椎间盘施加过度的旋转应变，导致椎间盘环撕裂。相比之下，其他研究未发现FT与IVDP之间存在明确关联。因此，目前缺乏关于FT在椎间盘突出症发病机制中作用的确凿证据。
分析了426例单节段腰椎IVDP患者的磁共振成像扫描结果。在轴位图像上测量腰椎节段的左右ZJA。通过计算左右ZJA之间的绝对差值来确定FT的频率和严重程度。L4-L5和L5-S1节段无IVDP的患者分别作为L4-L5和L5-S1节段有IVDP患者的对照。采用卡方检验和t检验比较有IVDP和无IVDP患者之间FT的严重程度和频率。进行受试者工作特征分析以确定预测IVDP的临界FT值。
与无IVDP的患者相比，IVDP患者的FT频率（L4-L5：47%对15.08%；L5-S1：39.62%对22.69%；p =0.001）和严重程度（L4-L5：7.85°±3.5°对4.05°±2.62°；L5-S1：7.30°±3.07°对4.82°±3.29°；p <0.001）更高。L4-L5节段临界FT值为5.7°，L5-S1节段为6°，分别使IVDP的发生可能性增加2.89倍和1.75倍。
我们的结果证实腰椎IVDP与FT之间存在显著关联；然而，无法确定因果关系。
