Grobler L J, Robertson P A, Novotny J E, Pope M H
Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Spine Institute of New England, Williston, Vermont.
Spine (Phila Pa 1976). 1993 Jan;18(1):80-91.
This study examined the role of facet joint morphology in the etiology of both degenerative spondylolisthesis and isthmic spondylolysis. To this end, the axial facet joint morphology of the lower lumbar spine in a normal population and in populations of patients with spinal stenosis or degenerative spondylolisthesis at L4-5 and in patients with isthmic spondylolysis at the L5 level were characterized. Computed tomographic scans were digitized, defining the axial morphology of the normal facet joint at five stations from proximal to distal within the joint. Assessments were made of facet joint orientation, transverse articular dimension, depth of the articular surface, and shape of the articular surface at levels L3-4, L4-5, and L5-S1. There was a gradually more coronal orientation from proximal to distal among the stations at each level, and a maximal transverse articular dimension at the level of the superior endplate of the caudad vertebra. Minimal error in the recording process at this level. In addition to the maximal joint dimension, made this level the most representative of the overall morphology and most useful for further studies. At the L4-5 level, a significantly more sagittal facet orientation was found in the degenerative spondylolisthesis group when compared to both the normal population and spinal stenosis groups (P < 0.01). At L5-S1, the only significant morphologic difference between the normal population and the patients with isthmic spondylolysis was reduced transverse articular dimension. These results support the hypothesis that patients developing degenerative spondylolisthesis are predisposed to this by a developmental sagittal orientation of the L4-5 facet joints.
本研究探讨了小关节形态在退变性腰椎滑脱症和峡部裂性腰椎滑脱症病因学中的作用。为此，对正常人群、L4 - 5节段患有椎管狭窄或退变性腰椎滑脱症的患者群体以及L5节段患有峡部裂性腰椎滑脱症的患者群体的下腰椎轴向小关节形态进行了特征描述。将计算机断层扫描数字化，确定关节内从近端到远端五个位置的正常小关节轴向形态。对L3 - 4、L4 - 5和L5 - S1节段的小关节方向、横突关节尺寸、关节面深度和关节面形状进行了评估。在每个节段的不同位置，从近端到远端小关节方向逐渐更加呈冠状位，并且在尾侧椎体上终板水平横突关节尺寸最大。该水平记录过程中的误差最小。除了最大关节尺寸外，这使得该水平最能代表整体形态，并且对进一步研究最有用。在L4 - 5节段，与正常人群和椎管狭窄组相比，退变性腰椎滑脱症组的小关节矢状位方向明显更多（P < 0.01）。在L5 - S1节段，正常人群与峡部裂性腰椎滑脱症患者之间唯一显著的形态学差异是横突关节尺寸减小。这些结果支持了这样的假设，即发生退变性腰椎滑脱症的患者是由于L4 - 5小关节的发育性矢状位方向而易于患此病。
