【作者】 卢海波；

【导师】 吴强；

【作者基本信息】 汕头大学 ， 外科学， 2010， 硕士

【摘要】 目的：①测量成人下颈椎关节突关节横断面长度、宽度及关节间隙大小等数据的正常值范围；②探讨其退变的评级方法,为临床观测提供量化的评级标准。方法①选用20例在读学生为正常组和40例颈椎病病人为病理组,分别行螺旋CT扫描并重建,测量下颈椎关节突关节横断面长度、宽度及关节间隙大小,计算出正常值范围；制定下颈椎关节突关节退变的评级标准。数据用SPSS 13.0统计软件包进行统计学分析,计算正常组、病理组各数据的均数及标准差；同一关节突关节左右数据间比较行配对T检验,正常组和病理组同一节段的各数据比较用独立样本T检验。②两名骨科医师、两名放射科医师依据上述标准评定40例颈椎病病人的160个下颈椎关节突关节的退变级别,一月后再次评级,不同观察者间的一致性、同一观察者两次评估的内部一致性,用加权kappa分析来检验。结果①正常组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm;关节突关节横断面宽度分别为：10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm；关节间隙中部(J2)最大,分别为：1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm;关节间隙两侧(J1、J3)略窄且基本对称。②病理组下颈椎关节突关节各测量数据左右差异均无统计学意义,取双侧均值。C3/4、C4/5、C5/6、C6/7关节突关节横断面长度分别为：10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm;关节突关节横断面宽度分别为：10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm;关节间隙中部(J2病)最大,分别为：1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm；关节间隙两侧(J1病、J3病)略窄且基本对称。③正常组和病理组间比较：C5/6关节面长度间差别有统计学意义；C4/5、C5/6关节面宽度间差别有统计学意义；C3/4、C4/5、C5/6、C6/7关节间隙大小间差别均有统计学意义；病理组关节突关节退变的特征表现为：关节突肥大、骨赘形成、关节面不规则、关节间隙狭窄、软骨下骨坏死、软骨下骨囊性变。④自行拟定的评级标准对40例颈椎病病人160个下颈椎关节突关节退变的评级结果,骨科医师与放射医师间的一致性KA1C1=0.659、KB1D1=0.705;高年资医师与低年资医师间的一致性KA1B1=0.688、KC1D1=0.677。四个评估者两次评估间的一致性KA-D=0.755-0.821。结论1.本研究的测量数据,为研究成人下颈椎关节突关节的影像解剖学提供了正常值参考。2.自行设计了一种新的下颈椎关节突关节退变的评级标准,分为0-Ⅲ级,该评级标准经临床检测是一个可靠的影像学评估方法,适用于不同经验、不同学科的医生。更多还原

【Abstract】 Object①To measure the normal range of data of adult lower cervical facet joint cross-sectional length, width and joint space size.②To explore the method of the assessment of facet joint degeneration, providing quantitative ratings-criterion for the clinical observations.Methods①Twenty students as normal group and fourty cervical spondylosis patients as pathological groups, respectively, scanned by the way of helical computer tomography and reconstruction, measuring the data of lower cervical facet joint cross-sectional length, width and joint space size, calculating the normal range; formulating ratings-criterion of lower cervical facet joint degeneration. To analyze the data by SPSS13.0, calculating the mean and standard deviation of all measurement of the normal group and pathological group, comparing the measurement of the same facet joint between left and right using the paired T test, comparing the measurement of same segment between normal group and pathological group using the independent samples T test.②Two orthopedic doctors, two radiologists assess one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on this criteria, after one month, reassess all levels; To analyze inter-rater agreement between the ratings of all raters and the intra-rater agreement between the ratings of the same rater using weighted kappa.Results ①The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the normal group, got the averaged measurements of both sides.Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.84±0.94mm、11.57±0.85mm、11.83±0.96mm、12.57±0.88mm; facet joint cross-sectional width:10.44±0.99mm、10.56±0.91mm、10.50±1.06mm、9.49±0.68mm; central joint space size (J2) were the most:1.49±0.12mm、1.44±0.10mm、1.43±0.09mm、1.45±0.11mm; joint space on both sides (J1, J3) are slightly narrower and the basic symmetry.②The difference is not statistically significant, which were compared that the two sides measurements of lower cervical facet joints in the Pathology group, got the averaged measurements of both sides. Facet joint cross-sectional length of C3/4、C4/5、C5/6、C6/7:10.83±0.83mm、11.44±0.85mm、12.26±0.70mm、12.67±0.74mm; facet joint cross-sectional width:10.55±0.98mm、10.98±1.06mm、10.96±0.85mm、9.75±0.81mm; central joint space size(J2病)were the most:1.34±0.17mm、1.30±0.27mm、1.34±0.17mm、1.25±0.12mm; joint space on both sides(J1病、J3病)are slightly narrower and the basic symmetry.③The comparisons of length of C5/6 between normal and pathological are statistically meaningful; the comparisons of width of C4/5、C5/6 between normal and pathological are statistically meaningful; the comparisons of joint space size of C3/4、C4/5、C5/6、C6/7 between normal and pathological are statistically meaningful. Degeneration of pathology group facet joints group of facet joint pathology is characterized by facet hypertrophy, osteophyte formation, articular surface irregularity, joint space narrowing, subchondral bone destruction and subchondral bone cystic.④The results of assessing one hundred and sixty lower cervical facet joints of fourty cervical spondylosis patients based on self-developed rating criteria, inter-rater agreement between orthopedic and radiologists surgeons KA1C1=0.659、KB1D1=0.705; inter-rater agreement between experienced and inexperienced raters KA1B1=0.688, KC1D1=0.677. inter-rater agreement between the ratings of all raters KA-D=0.755-0.821. Conclusions1. Measurements of this study provide the normal reference of studying imaging anatomy of adult lower cervical facet joints;2. Self-designed rating criteria of degeneration of lower cervical facet joints is new, which can be divided into 0-Ⅲgrade, This ratings-criterion is a reliable imaging assessment method with clinical testing, which can be used by both experienced as well as inexperienced doctors from different disciplines.更多还原