Eroğlu Ahmet, Sarı Enes, Cüce Ferhat, Tok Fatih, Atabey Cem, Düz Bülent
Department of Neurosurgery, Van Military Hospital, Van, Turkey.
Department of Orthopedics and Traumatology, Aksaz Military Hospital, Muğla, Turkey.
Turk J Phys Med Rehabil. 2017 Aug 7;63(3):253-258. doi: 10.5606/tftrd.2017.295. eCollection 2017 Jun.
This study aims to evaluate facet tropism in younger patients with lumbar spondylolysis and to investigate the role of facet tropism in the development of spondylolysis.
Between February 2013 and December 2015, a total of 102 male patients with bilateral L5 pars defect including 53 with spondylolysis and 49 control subjects were included in this case-control study. The facet joint angles were measured bilaterally and axially at the level of L3-4, L4-5, L5-S1 using computed tomography (CT). The classification was made as follows: A difference between two reciprocal facet joint angles of <6° indicated no tropism, 6°-12° indicated moderate tropism, and >12° indicated severe tropism.
A total of 612 angles including 318 facet joint angles from 53 patients with spondylolysis and 294 facet joint angles from 49 control subjects were measured. L3-4 measurements in the control group showed no tropism in 87.8% (n=43), moderate tropism in 12.2% (n=6), and severe tropism in 0% (n=0). L4-5 measurements in control group showed no tropism in 79.6% (n=39), moderate tropism in 20.4% (n=10), and severe tropism in 0% (n=0). L5-S1 measurements in the control group showed no tropism in 69.4% (n=34), moderate tropism in 28.6% (n=14), and severe tropism in 2.0% (n=1). The mean facet joint angles in the spondylosis group were 32.9±5.1°, 37.5±5.4°, and 41.2±7.8° at the levels of L3-4, L4-5, and L5-S1, respectively. The mean facet joint angles of the control group were 33.2±5.7°, 39.7±4.9°, and 42.2±4.9° at the levels of L3-4, L4-5, and L5-S1, respectively, indicating no significant difference between the right and left mean facet joint angles between the groups (p>0.05). The frequency of facet tropism and the difference between right and left facet joint angles for all three levels were significantly higher in the spondylolysis group (p<0.05). Facet tropism at the level of L5-S1 was significantly more frequent than facet tropism at L3-4 level (p<0.05).
Our study results show that the rate of facet joint tropism is higher in the patients with spondylolysis, suggesting that facet tropism seems to play a role in the etiology of spondylolysis as a predisposing factor.
本研究旨在评估年轻腰椎峡部裂患者的关节突不对称性，并探讨关节突不对称性在峡部裂发生发展中的作用。
在2013年2月至2015年12月期间，本病例对照研究共纳入102例双侧L5椎弓根峡部裂男性患者，其中53例为峡部裂患者，49例为对照受试者。使用计算机断层扫描（CT）在L3 - 4、L4 - 5、L5 - S1水平双侧及轴向测量关节突关节角度。分类如下：两个相对关节突关节角度之差<6°表示无不对称，6° - 12°表示中度不对称，>12°表示重度不对称。
共测量612个角度，其中53例峡部裂患者的318个关节突关节角度和49例对照受试者的294个关节突关节角度。对照组L3 - 4测量显示，87.8%（n = 43）无不对称，12.2%（n = 6）为中度不对称，0%（n = 0）为重度不对称。对照组L4 - 5测量显示，79.6%（n = 39）无不对称，20.4%（n = 10）为中度不对称，0%（n = 0）为重度不对称。对照组L5 - S1测量显示，69.4%（n = 34）无不对称，28.6%（n = 14）为中度不对称，2.0%（n = 1）为重度不对称。峡部裂组在L3 - 4、L4 - 5和L5 - S1水平的平均关节突关节角度分别为32.9±5.1°、37.5±5.4°和41.2±7.8°。对照组在L3 - 4、L4 - 5和L5 - S1水平的平均关节突关节角度分别为33.2±5.7°、39.7±4.9°和42.2±4.9°，表明两组间左右平均关节突关节角度无显著差异（p>0.05）。峡部裂组所有三个水平的关节突不对称频率及左右关节突关节角度之差均显著更高（p<0.05）。L5 - S1水平的关节突不对称明显比L3 - 4水平更常见（p<0.05）。
我们的研究结果表明，峡部裂患者的关节突关节不对称发生率更高，提示关节突不对称似乎作为一个易感因素在峡部裂的病因学中起作用。
