| BackgroundIn recent years,people began to conduct a detailed study of the lumbar facet joint arthritis caused by small,most of the mechanism of the occurrence and development of pain,including lumbar disc degeneration in the elderly population in the incidence is relatively common,this is the main cause of low back pain,lumbar activity process may cause lumbar facet joint position the corresponding changes,and the lumbar facet joint degeneration will also affect the changes of lumbar intervertebral disc,lumbar facet joint activities and the direction of its biomechanical function or correlation with various pathological changes is still controversial.However,there is still little research on the facet joint.Under normal circumstances,the sagittal facet orientation to spinal flexion and extension,and the limit of axial rotation.The research shows that the sagittal orientation of facet joints is associated with multiple factors,this study will analyze the system mainly includes the main influencing factors of age,BMI,intervertebral disc degeneration,spondylolisthesis PI and lumbar facet joint osteoarthritis,to investigate the relationship between the lumbar sagittal orientation of facet joints and these factors.Most of the previous studies have considered the influence of single factor on facet joint angle.We can see from the human anatomy,lumbar spine functional unit is composed of the front intervertebral disk and rear sides of the facet joint,so as to form a stable structure—three joint complex,which maintain flexion,lateral bending and other basic activities.ObjectiveThe purpose of this study is to investigate the pathogenesis of sagittal orientation of lumbar facet joint on age,BMI,intervertebral disc degeneration,spondylolisthesis PI and lumbar facet joint osteoarthritis,lays the foundation for the further study of pathogenesis of sagittal orientation of facet joints,which also caused people further understanding on the sagittal orientation of facet joints.Methods and Materials1.Study on the correlation between 1umbar facet joint angle and age,BMI.First of all,according to the age was divided into 6 groups:?30 years,31-40,41-50,51-60,61-70,>70 years old,each group of 30 patients.In strict accordance with the inclusion,exclusion criteria and inclusion requirements,after a rigorous match,a total of 180 cases of patients in our hospital from September 2014 to October 2016 were selected in accordance with the inclusion criteria.All patients were taken L3~4,L4~5 and L5~S1 images in three segments of lumbar facet joint magnetic resonance,and get the T2 WI axial images,for the assessment of small joint angle measurement,and for each patient were calculated BMI by measured height and weight,all the collected data for statistical analysis by SPSS statistics software.The relationship between the changes of facet joint angle and BMI and facet angle were compared between different age groups,and the correlation between age,BMI and facet angle was discussed.2.Research on the correlation between the lumbar facet joint angle and the degree of lumbar disc degeneration.Collected from September 2014 to October 2016 in our hospital inpatient and outpatient department of orthopedics with lumbar disc degeneration in patients with a total of 600 cases were retrospectively analyzed: firstly,according to the severity of lumbar disc degeneration were divided into mild,moderate and severe 3 groups,each group select 60 cases,a total of 180 patients.In strict standard with the inclusion,exclusion criteria,include age,gender and body mass index,a total of 180 patients with lumbar intervertebral disc degeneration were collected.All cases were treated with 3.0T MR scaning the L4-5 lumbar intervertebral disc and facet joint,obtain transverse T2 WI images,respectively for the assessment and classification of lumbar disc degeneration and facet joint angle measurement.To identify the relationship between different degree of intervertebral disc degeneration and lumbar facet joint angle.3.Study on the correlation between the facet joint angle and the pelvic incidence.A retrospective analysis of our hospital from March 2013 to October 2016,the criteria for patients with a total of 450 cases,all cases were taken MRI of the lumbar spine and standing lateral lumbar spine X-ray,which measured the joint angle on lumbar transverse MRI images,and the angle of pelvic incidence(PI)on pelvic X-ray films.Then all the cases on the basis of PI angle measurement is divided into less than the normal group(?35.5°),normal group(35.5°-54.7 °),more than the normal group(?54.7°),each group of 40 patients,meet the requirements total of 120 patients.According to the PI group,analyzed the changes of facet joint angles,and compared the changes of facet angle with PI.4.Study on the correlation between lumbar facet joint angle and degenerative spondylolisthesis.From September 2015 to October 2016,we were retrospectively analyzed in the department of orthopedics in our hospital,which include 300 patients with degenerative lumbar spondylolisthesis patients and 200 asymptomatic persons of the inspection data.All cases and controls were scanned by MRI image,and measurement of L4-5 facet joint angle on disc axial scanning images.To compare the difference between the small joint angle of the spondylolisthesis patients and the normal population.SPSS23.0 was used to analyze the measured data.The comparison between the two groups was carried out by using independent sample t test.5.Study on the correlation between facet joint angle of 2 lumbar vertebrae and lumbar facet joint osteoarthritisA total of 300 patients with lumbar facet joint osteoarthritis were enrolled in the Department of orthopedics of the First Affiliated Hospital of Nanchang University from January 2014 to February 2016.According to the inclusion and exclusion criteria,a total of 60 patients met the inclusion criteria.CT and MRI images were obtained in all cases,and the L4-5 facet joint angles were measured on the axial scan images of the intervertebral discs.To compare the difference between the degenerative grade and the facet joint angle.SPSS23.0 was used to analyze the measured data,and the data were analyzed by independent sample t test and correlation analysis using Pearson test.Results1.The correlation between lumbar facet joint angle and age,BMI.(1)Divided age into 6 groups,each group measured the facet joint angle respectively with L3~4,L4~5 and L5~S1 of the three lumbar segment,we found that there was statistically significant difference between lumbar facet joint angle of each segment of the case group and the age(P<0.001);a high correlation between the age and each segment of the joint angle(L3~4 r=0.959,L4~5 r=0.794 and L5~S1 r=0.967).(2)We found that there was no significant difference in the facet joint angle and BMI(21.31 +.1.56)in each group(P>0.05).2.The correlation between lumbar facet joint angle and the degree of Lumbar intervertebral disc.L4~5 lumbar facet joint angle and the degree of degeneration of lumbar intervertebral disc were significantly different(P<0.01).There was a certain correlation between Lumbar intervertebral disc and facet joint angle(r=0.46).3.The correlation between the facet joint angle and PI.There was statisticallysignificant difference between the pelvic incident angle changes and lumbar facet joint angle on the L4~L5(P<0.01),and with the increasing of pelvic incidence,lumbar facet joint angle is decreased gradually,with a high degree of correlation with them(r=0.926).4.The correlation between lumbar facet joint angle and degenerative lumbar spondylolisthesis.In the control group and the case group,there was statistically significant difference in lumbar facet joint angle(P<0.01),and the facet joint angle was significantly reduced in patients with the severity of degenerative spondylolisthesis.5.The correlation between lumbar facet joint angle and Lumbar facet joint osteoarthritisAfter analysis and comparison showed that changes of lumbar facet joint angle and joint of different degeneration degree has obvious difference(P<0.05),small joint angle decreases with the increase of facet joint degeneration degree(r=-0518).Conclusion:1.With the lumbar segment axial position down,the facet joint angle reduces gradually;and the sagittal orientation of facet joint angle and age was positively correlated.However there was no significant on BMI and sex,this may be the increase of age would be more likely to cause facet jiont degeneration resulting in sagittal angle.2.There is a positive correlation between the L4-5 facet joint angle and lumbar intervertebral disc degeneration.It is speculated that the degeneration of lumbar intervertebral disc is the main factor that leads to the facet joint.3.We found that PI is larger than the normal range,which can lead to or increase the sagittal angle of the facet joint of L4~5 segment,and the PI and the facet joint angle L4~5 segments are significantly correlation.4.There was a positive correlation between the lumbar facet joint angle of normal control group and degenerative lumbar spondylolisthesis group,which indicated that degenerative lumbar spondylolisthesis may be another main factor of lumbar facet joint.5.Lumbar facet joint angle with the increase of the degree of degeneration of the lumbar facet joints,the more inclined to the sagittal,which shows that the degeneration of small joints is likely to cause small joints sagittal important factors,leading to lumbar instability. |
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