退变性腰椎侧凸形成和发展的相关因素分析  

Analysis of factors of formation and development about degenerative lumbar scoliosis

作　　者：丁文元[1] 曹来震[1] 申勇[1] 张为[1] 王林峰[1] 李宝俊[1] 孙亚澎[1] 郭金库[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华外科杂志》2011年第5期404-408,共5页Chinese Journal of Surgery

摘　　要：目的探讨退变性腰椎侧凸患者椎间盘的不对称指数、腰椎间盘退变程度以及骨密度降低对侧凸角度的影响。方法采用回顾性研究的方法，选取2002年1月至2010年8月，共96例退变性腰椎侧凸患者为研究对象（侧凸组）；2002年1月至2010年8月确诊为腰椎管狭窄症并且资料齐全的患者96例为对照组；两组间性别、年龄、体质量指数匹配。侧凸组：在腰椎正位x线片上测量凸凹侧顶椎间盘及其上下椎间盘的高度和顶椎及其上下椎体的高度，利用AdobePhotoshop6．0软件，测量MRI图像T2WI顶椎及其上下椎间盘内髓核与脑脊液的相对信号强度。对照组：取L3-4、L4-5这3个椎间盘为研究对象测定上述指标。应用双能X线吸收法测定两组患者腰椎（L2-4）及股骨颈、股骨粗隆和Ward’s三角的T值。结果侧凸组凸侧椎间盘高度和为（40±7）mm高于凹侧的（28±7）mm（P〈0．01），凸侧椎体高度和为（76±12）mm高于凹侧的（72±10）113_113（P=0．016）；两组之间的椎间盘退变程度差异有统计学差异（P=0．003）；两组之间骨密度T值的平均值和骨质疏松的发生率差异有统计学意义（均P〈0．01）。通过多元线性回归分析结果显示患者椎间盘的不对称指数、椎间盘的退变程度、骨密度T值影响退变性腰椎侧凸角度。结论退变性腰椎侧凸常伴有凸凹两侧椎间盘高度以及椎体高度不对称。侧凸角度与椎间盘的不对称指数、椎间盘的退变程度呈正相关，与骨密度值T值呈负相关。[ Abstract] Objectives To investigate the correlation between scoliosis angle and the asymmetric index of degenerative lumbar scoliosis, the degree of intervertebral disc degeneration, decreased bone density. Methods As a retrospectively study,a total of 96 patients with degenerative lumbar scoliosis were retrospectively enrolled from January 2002 to August 2010 as scoliosis group, meanwhile 96 patients with lumbar spinal stenosis matched in gender, age and body mass index （BMI） were selected as control group. All patients were studied with plain radiographs, MRI and dual energy X-ray absorptiometry at presentation. Radiographic measurements include Cobb angle, the height of the convex and concave side of the apical disc and the contiguous disc superiorly and inferiorly, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly in scoliosis group, the height of L2-3 , L34, L4-5 discs and the height of L2-4 vertebral body in control group. The average relative signal intensity of lumbar intervertebral disc and cerebrospinal fluid in T2WI sagittal image was measured in apex intervertebral disc and adjacent discs by Adobe Photoshop 6. 0 in scoliosis group, which was measured in L2-3 , L3-4, L4-5 disc in control group. The bone density of lumbar, femoral neck, troehanter, and Ward＇s triangle regions were measured with dual-energy X-ray absorptiometry. Results The intervertebra] disc height in convex side was greater than the height in the concave side [ （40 ± 7 ）mm vs. （ 28 ± 7 ） ram, P 〈 0. 01 ] , the vertebral body height in convex side was greater than the height in the concave side [ （76 ±12）mm vs. （72 ± 10）mm, P = 0.016] in scoliosis group. There was significant statistically difference in the degenerative degree of intervertebral discs between two groups （ P = 0. 003 ）. There was significant statistically difference of the average T-value and the rate of osteoporosis between two groups （ P 〈 0. 01 ）. Multiple linear

关 键 词：脊柱侧凸 骨质疏松 椎间盘 退变 

分 类 号：R682.3[医药卫生—骨科学]