0? 2? 0? Lumbar facet joint refers to the articular process joint, and there are abundant nerve endings in the joint capsule, and the synovium in the joint capsule is also rich in myelinated nerve fibers and capillaries. Lumbar facet joints are close to sagittal position, which is beneficial to lumbar flexion and extension. When it is beyond the range of motion and cannot be reset, it will embed into synovium and joint capsule, causing clinical symptoms such as low back pain and limited lumbar motion, which is called lumbar facet joint disorder. 1. Etiology 1. Dislocation of facet joints: it is common in intervertebral disc degeneration, narrowing of intervertebral space and abnormal closure of upper and lower articular processes. The relaxation of joint capsule and ligament leads to the gap of facet joint during normal activity. 2. Synovial incarceration of facet joints: Due to improper lumbar force, severe low back pain suddenly appeared, and lumbar motion was obviously limited. The reason is that the joint capsule folds and synovium are embedded in the joint space, which compresses the nerve endings. 3. Osteoarthritis of facet joints: Chronic strain leads to hyperosteogeny, hypertrophy and adhesion of facet joints. Second, the clinical manifestations? 0? 2? 0? 2? 0? More common in middle-aged people, women are more than men. There is often a history of chronic low back pain, and there is no obvious history of external injury. During normal activities, there is sudden and severe pain in the waist, unclear posture, obviously limited waist activity, and difficulty in turning over at night. Physical examination: Sacrospinous muscle spasm, deep tenderness of lumbar facet joints, no neurological signs of lower limbs, straight leg elevation test (-). Third, the auxiliary examination 1. X-ray film: it can be seen that the facet joints are asymmetrical, the joint space is enlarged, overlapped and degenerated. Secondary changes such as scoliosis and the disappearance of lumbar lordosis may occur. 2.CT: Hyperplasia of articular process, widening of joint space, abnormal healing, joint mutation, subchondral sclerosis, intra-articular fracture, hydrops and pneumatosis can be seen. 4. Diagnostic points and differential diagnosis? 0? 2? 0? 2? 0? According to the medical history, clinical manifestations and typical signs, the diagnosis is not difficult. 1. intervertebral disc pain: intervertebral disc degeneration can also cause facet joint disorder, so it is difficult to distinguish it from intervertebral disc pain. The pain disappears quickly after simple facet joint disorder reduction, and it is not easy to recur. Discogenic pain is persistent and difficult to completely relieve. 2. Lumbar muscle strain: chronic low back pain, no history of acute external injury. Sour swelling and pain, relieved after rest, recurrent attacks. There are relatively fixed tenderness points near the starting and ending points of muscles. 3. Inflammation of supraspinous interspinous ligament: chronic low back pain, limited to the posterior median area of the waist. The tender point is located between spinous process and spinous process and does not radiate. 4. The third lumbar transverse process syndrome: sacral spinous muscle spasm, tenderness at the tip of the third lumbar transverse process. Local blocking has good curative effect. 5. Acute lumbar sprain: there is a clear history of trauma, and the tenderness at the muscle attachment point is obvious, and the pain disappears after local closure. Five, the principle of treatment 1. Bed rest, oral painkillers and spasmolytics. 2. Skew reduction: a safe, rapid and effective method to relieve severe low back pain and muscle spasm. No anesthesia is needed, and the impacted synovium can be relieved by relaxing the back muscles and quickly rotating and resetting. 3. Acupuncture, massage and physical therapy: it can promote blood circulation and relieve pain, but it can't cure it. 4. Local sealing: the analgesic effect is good in a short time. 5. Lumbar back muscle function exercise: enhance the stability of lumbar spine and prevent recurrence. 6. Surgical treatment: conservative treatment is ineffective, which seriously affects life and workers. Lumbar joint capsule and synovial membrane resection are feasible.