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1、Pathogenesis,Diagnosis,andTreatmentofLumbarZygapophysial(Facet)JointPainStevenP.Cohen,M.D.,*SrinivasaN.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ThisarticlehasbeenselectedfortheAnesthesiologyCMEProgram.Afterreadingthearticle,gotohttp://www.asahq.org/journal-cmetotakethetestandapplyforC
2、ategory1credit・CompleteinstructionsmaybefoundintheCMEsectionatthebackofthisissue・Lumbarzygapophysialjointarthropathyisachallengingconditionaffectingupto15%ofpatientswithchroniclowbackpain.Theonsetoflumbarfacetjointpainisusuallyinsidious5withpredisposingfactorsineludingspondylolist
3、hesis,degenerativediscpathology,andoldage・Despitepreviousreportsofa'lacetsyndrome,”theexistingliteraturedoesnotsupporttheuseofhistoricorphysicalexaminationfindingstodiagnoselumbarzygapophysialjointpain.Themostacceptedmethodfordiagnosingpainarisingfromthelumbarfacetjointsiswithlow-
4、volumeintraarticularormedialbranchblocks,bothofwhichareassociatedwithhighfalse-positiverates.Standardtreatmentmodalitiesforlumbarzygapophysialjointpainineludeintraarticularsteroidinjectionsandradiofrequencydenervationofthemedialbranchesinnervatingthejoints,buttheevidencesupporting
5、bothoftheseisconflicting.Inthisarticle,theauthorsprovideacomprehensivereviewoftheanatomy,biomechanics,andfunctionofthelumbarzygapophysialjoints,alongwithasystematicanalysisofthediagnosisandtreatmentoffacetjointpain.腰椎小关节病占慢性腰痛的15%,已成为极具挑战性的课题。腰椎小关节源性疼病常常隐匿起病，伴冇既往椎体滑脱、椎间盘退变、和老龄等问题。
6、尽管以前曾报道多“小关节综合征”，然而H前的文献多不支持采川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。标准的质杲方式包括关节内注射类同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。在木文中，作者综介阐述了腰椎小关节源性疼病相关的解剖，生物力学，和功能特点，并对诊断和治疗做了系统分析。SINCEitsoriginaldescriptionalmost100yrago,thousandsofscientificarticleshavebeenpublishedo
7、nlumbarzygapophysial(l-z)jointpain,andfacetinterventionsrepresentthesecondmostcommontypeofprocedureperformedinpainmanagementcentersthroughouttheUnitedStates.1Butdespitetheplethoraofresearchandclinicalemphasisonthisdisorder,almosteveryaspectofl-zjointpain,fromdiagnosistotreatment,r
8、emainsmiredincontroversy・Evenamon
