人类腰椎小关节损伤与椎间盘退变。
Human lumbar apophyseal joint damage and intervertebral disc degeneration.
作者信息
Swanepoel M W, Adams L M, Smeathers J E
机构信息
School of Mechanical Engineering, University of the Witwatersrand, Transvaal, South Africa.
出版信息
Ann Rheum Dis. 1995 Mar;54(3):182-8. doi: 10.1136/ard.54.3.182.
OBJECTIVES
To record the extent and location of lumbar apophyseal cartilage damage, and to ascertain if the extent of damage is correlated with the grade of disc degeneration, age, or both.
METHODS
The extent and location of fibrillated areas of the apophyseal cartilage of the joint surfaces of 29 lumbar motion segments were examined using computer aided image processing of Indian ink stained areas, and degeneration of the associated intervertebral discs graded using the method of Nachemson.
RESULTS
It was found that these joints showed a greater extent and prevalence of cartilage fibrillation than the knee, hip or ankle, with significant damage in specimens younger than 30 years. Damage was predominantly located peripherally, superiorly, and posteriorly in the concave superior apophyseal surfaces, and was predominantly peripheral and posterior in the inferior surfaces, with a tendency to be located inferiorly. There was a weak correlation between apophyseal joint damage and the intervertebral disc degenerative grade, but this was inconclusive, as both increased with age.
CONCLUSIONS
The pattern of damage exhibited by superior joint surfaces is most probably caused by tension on collagenous joint capsule fibres which insert into the surfaces posteriorly, so producing an area of fibrocartilage unsuited to loadbearing. Tension on such fibres would be greatest during spinal flexion. The pattern of damage of the inferior surfaces lends some support to the hypothesis that their apices impact the laminae of the lumbar vertebra inferior to them, consequent upon the degeneration and narrowing of the associated intervertebral disc. The predominantly peripheral location of fibrillation of both superior and inferior surfaces may be associated with inadequate mechanical conditioning of marginal joint areas. Disc degeneration cannot be the initial cause of apophyseal fibrillation in most specimens. The study indicates a need for regular spinal exercise, starting at a young age.
目的
记录腰椎小关节软骨损伤的范围和位置，并确定损伤程度是否与椎间盘退变程度、年龄或两者相关。
方法
使用计算机辅助图像处理技术对29个腰椎运动节段关节面的小关节软骨纤维化区域的范围和位置进行检查，并采用纳赫姆森方法对相关椎间盘退变进行分级。
结果
发现这些关节的软骨纤维化程度和发生率高于膝关节、髋关节或踝关节，在30岁以下的标本中存在明显损伤。损伤主要位于上关节凹面的周边、上方和后方，下关节面的损伤主要位于周边和后方，且有向下的趋势。小关节损伤与椎间盘退变程度之间存在弱相关性，但由于两者均随年龄增加，因此尚无定论。
结论
上关节面的损伤模式很可能是由于插入后方关节面的胶原关节囊纤维受到张力所致，从而产生了一个不适合承重的纤维软骨区域。在脊柱屈曲时，这些纤维上的张力最大。下关节面的损伤模式为以下假设提供了一些支持，即由于相关椎间盘退变和狭窄，其顶点撞击下方腰椎的椎板。上下关节面纤维化主要位于周边，可能与边缘关节区域机械调节不足有关。在大多数标本中，椎间盘退变不可能是小关节纤维化的初始原因。该研究表明需要从年轻时就开始定期进行脊柱锻炼。
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