| BackgroundDegenerative lumbar spondylolisthesis(DLS)is a common disease in orthopaedic department in China.It usually occurs in middle-aged and elderly women over 40 years of age.It often involves the L4~L5 stage.It is often caused by lumbar degenerative degeneration to cause the displacement of adjacent vertebrae,and the isthmus of pedicle remains intact.The symptoms such as pain of waist and leg,sciatic nerve involvement and intermittent claudication can seriously affect the quality of life of patients.It is of great clinical significance to prevent,diagnose and take reasonable treatment measures to alleviate the pain of the patients and improve the quality of life.There are many etiology and pathogenesis of DLS,but no conclusion has been reached yet.The main mechanisms were as follows:(1)Age sex and BMI factors: the incidence of DLS increased with the increase of age,which occurred in menopausal or postmenopausal women,and the incidence of DLS in women was 4 times higher than that in men.The causes may be related to hormone imbalance and osteoporosis in postmenopausal women.(2)Lumbar facet joint degeneration: the degeneration of lumbar facet joint will not only cause the occurrence of DLS,but also lead to its progress.Eventually.Causes the patient's lumbar vertebrae facet joint to appear the subluxation or the malmatch and so on the question;(3)degeneration of lumbar intervertebral disc: there is a synergistic effect between degeneration of lumbar intervertebral disc and degeneration of facet joint of lumbar vertebrae.The loss of height of degeneration of intervertebral disc caused by degeneration caused abnormal stress on intervertebral facet articular surface,which resulted in destruction of facet articular surface.Osteogenesis,sagittal change,reduced ability to resist slippage,resulting in DLS;(4)the physiological structure and curvature of lumbar vertebrae: because of the relative stability of L5 vertebra,L4 vertebra withstands the supporting pressure of ligaments,plus L4 vertebra is higher than the line of two iliac crest,the protection of soft tissue and pelvis is less.Moreover,the pedicle chasing and intervertebral joints are horizontal and the supporting ligaments are less and weaker,so the resistance of the facet joints to the L4 anterior sliding force will be reduced,so it is easy to slip and so on.It can be seen that lumbar facet joint disease plays a very important role in the pathogenesis of DLS.Clinical research on lumbar facet joint disease has been carried out one after another,and the spatial tendency of lumbar facet joint.Significant conclusions have been obtained in the studies of left and right dissymmetry of articular process and osteoarthritis of facet joint caused by degeneration.In recent years,the research on the angular change of facet articular surface of vertebrae has been carried out gradually,but the facet joint of lumbar vertebrae is stereoscopic,so it is not enough to evaluate the whole three-dimensional facet joint of lumbar vertebrae by observing only the angle of one plane.The development of DLS is also a continuous process.How to evaluate the angle of facet joint in different degree of DLS patients and estimate the possibility of disease progression according to its angular condition.Therefore,In this study,we observed and measured the three-dimensional angular changes of lumbar facet joints in normal group,DLS ? group and DLS ? group,and analyzed and compared their significance.We hope to provide some reference for clinicians on the pathogenesis and progression of DLS.Purpose:To study the coronal,sagittal and cross-sectional changes of lumbar facet joints in normal subjects and(DLS)patients with degenerative lumbar spondylolisthesis.To study the clinical correlation between three-dimensional angular changes of lumbar facet articular surface and DLS and progression.Methods:Retrospective case-control analysis was used.From December 2016 to December 2018,92 outpatients and inpatients in our hospital were selected,including 62 patients with L4 DLS,30 patients with normal group,30 patients with grade ? DLS32 and group B with grade ? DLS30.The angle of L4~L5 facet joint on coronal plane,sagittal plane and cross section was measured by X-ray and CT machine of the same type in our hospital.Results:The general situation of the three groups was compared:Chi-square test was used for all sex distribution,?2=0.8090,P=0.6673(P>0.05).It can be concluded that there is no difference in gender distribution among the three groups.The BMI index of the three groups was tested by chi-square test,?2=3.1241,P=0.5373(P>0.05).It can be concluded that there is no difference in the distribution of gender and BMI index among the three groups.The age of all patients was measured by independent sample t test.The average age of all patients was more than 0.05,which had no statistical significance.(1)The results were as follows:(1)the angle of L4~L5 facet articular surface on the coronal plane,the mean angle of bilateral facet joint were 33.6 o ±5.3 o in normal group,25.3 o ±4.3 o in group A,20.7 o ±2.4 o in group B,respectively.There was significant difference among the three groups(P < 0.05).There was no significant difference between group B(7.2 o±1.3 o)and group A(6.5 o±1.7 o)(P > 0.05),A(6.5 o±1.7 o),which was significantly higher than that in normal group(2.6 o±1.2 o)(P < 0.05).(2)The angle of articular facet of L4~L5 on sagittal plane was significantly higher in group A(14.3 o±2.7 o)than that in normal group(11.5 o ±3.2 o)(P < 0.05).Group B(20.4 o ±1.4 o)was significantly higher than group A(14.3 o ±2.7 o)(P < 0.05),that is,the angle of sagittal facet joint of group A was more horizontal than that of normal group,and the angle of sagittal facet joint of group B was more horizontal than that of group A.(3)Angle comparison of L4~L5 facet articular surface on cross section: head side: mean angle of bilateral facet joint: LFA of normal group was 48.3 o ±4.9 o;The LFA of group A was 35.5 o ±4.7 o,the LFA of group B was 27.6 o ±5.1 o.There was significant difference among the three groups(P < 0.05),the mean angle of small joint of caudal side was 45.4 o ±5.2 o in normal group and 45.4 o ±5.2 o in normal group.The LFA of group A was 33.4 o ±6.3 o,and the LFA of group B was 25.5 o ±4.7 o.There was significant difference among the three groups(P < 0.05).(4)Comparison of angle difference between two facet joints: there was significant difference between normal group(2.6 o±1.2 o)and group A(6.5 o±1.7 o)on coronal plane(P < 0.05).There was significant difference between normal group(2.6 o ±1.2 o)and group B(7.2 o±1.3 o)(P < 0.05).The difference between normal group(3.7 o±1.4 o)and group A(8.3 o ±4.4 o)was statistically significant(P < 0.05),and the difference between normal group(3.7 o±1.4 o)and group B(9.1 o ±3.7 o)was uniform(P < 0.05).The significance of calculation was significant(P < 0.05).There was no significant difference in bilateral coronal difference between group A(6.5 o ±1.7 o)and group B(7.2 o ±1.3 o),and between group A(8.3 o ±4.4 o)and group B(9.1 o ±3.7 o)(P > 0.05).Conclusion:The sagittal,horizontal sagittal plane,vertical coronal plane and asymmetrical trend of both sides of lumbar facet joint will cause the instability of lumbar facet joint in the sagittal section,horizontal sagittal plane,vertical coronal plane and asymmetrical trend on both sides of the facet joint of lumbar vertebrae.It leads to the aggravation of lumbar facet osteoarthritis and the degeneration of triple joint complex,which leads to the aggravation of spondylolisthesis,which has certain influence and reference value on the early prevention and intervention,clinical progress and treatment evaluation of DLS patients. |
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