下腰痛小关节突源性腰痛的发病机制,诊断和治疗..doc

Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint PainSteven P. Cohen, M.D.,* Srinivasa N. Raja, M.D.?腰椎关节突关节（小关节）源性腰痛的发病机制，诊断和治疗This article has been selected for the Anesthesiology CME Program. After reading the article, go to /journal-cme to take the test and apply for Category 1 credit. Complete instructions may be found in the CME section at the back of this issue.Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low backpain. The onset of lumbar facet joint pain is usually insidious,with predisposing factors including spondylolisthesis, degenerativedisc pathology, and old age. Despite previous reports of a“facet syndrome,” the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article,the authors provide a comprehensive review of the anatomy,biomechanics, and function of the lumbar zygapophysial joints,along with a systematic analysis of the diagnosis and treatmentof facet joint pain.腰椎小关节病占慢性腰痛的15%，已成为极具挑战性的课题。腰椎小关节源性疼痛常常隐匿起病，伴有既往椎体滑脱、椎间盘退变、和老龄等问题。尽管以前曾报道多“小关节综合征”，然而目前的文献多不支持采用组织学或体格检查的方式诊断小关节源性疼痛。最令人接受的诊断方式是采用微量关节内注射或内侧支阻滞的方法，然而两者的假阳性率都较高。标准的质量方式包括关节内注射类固醇和射频消融支配关节的内侧支。但是这两种治疗方法也存在争议。在本文中，作者综合阐述了腰椎小关节源性疼痛相关的解剖，生物力学，和功能特点，并对诊断和治疗做了系统分析。SINCE its original description almost 100 yr ago, thousands of scientific articles have been published on lumbarzygapophysial (l-z) joint pain, and facet interventions represent the second most common type