腰腿痛患者肥胖与腰椎间盘退变程度的相关性研究  

A correlative study between obesity and lumbar disc degeneration in the patients with low back and leg pain

作　　者：陈旭狮 桑朝辉[1] 彭楷文[1] 宋祖坤 张嘉伟[1] 瞿东滨[1] 江建明[1] CHEN Xu-shi SANG Chao-hui PENG Kai-wen SONG Zu-kun ZHANG Jia-wei QU Dong-bin JIANG Jian-ming(Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, PRC)

机构地区：[1]南方医科大学南方医院脊柱骨科,广州510515

出　　处：《中国骨与关节杂志》2016年第11期868-872,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金面上项目(81272022)

摘　　要：目的探讨腰腿痛患者肥胖对腰椎间盘退变的影响及规律。方法纳入2014年1月至2015年12月,因腰腿痛就诊于我院脊柱骨科门诊的329例腰椎管狭窄症或腰椎间盘突出症患者,收集患者的身高、体重、性别、年龄、高血压史、糖尿病病史、抽烟史、职业等资料,采用疼痛视觉模拟评分(visual analogue scale,VAS)评估其腰痛程度。计算体质量指数(body mass index,BMI),根据BMI值分为正常组(BMI>18.5 kg/m^2~<24.0 kg/m^2)、超重组(BMI≥24 kg/m^2~<28 kg/m^2)及肥胖组(BMI≥28 kg/m^2)。所有患者均已行腰椎MRI检查,采用Pfirrmann椎间盘退变分级分析腰椎每一节段椎间盘。统计分析腰腿痛患者中肥胖对腰椎间盘退变的影响及规律。结果各组患高血压情况:肥胖组26例(40.6%),超重组27例(22.0%),正常组17例(12.0%),肥胖组与超重组、肥胖组与正常组之间高血压病的比例差异有统计学意义(P<0.05);3组患者性别、年龄、糖尿病的比例、抽烟的比例及职业等一般资料差异无统计学意义(P>0.05)。L_(1~2)节段各组3级椎间盘,肥胖组为20例(31.3%),超重组为33例(26.8%),正常组为26例(18.3%),与正常组相比,肥胖组L_(1~2)节段的3级椎间盘比例显著增高(P<0.05)。L_(2~3)节段中3组之间不同分级的椎间盘比例差异无统计学意义(P>0.05)。L_(3~4)节段各组1~2级、4级、5级椎间盘,肥胖组分别为14例(21.9%)、18例(28.1%)、4例(6.3%),超重组分别为41例(33.3%)、27例(22.0%)、2例(1.6%),正常组分别为68例(47.9%)、20例(14.1%)、0例(0.0%),与正常组相比,肥胖组及超重组L_(3~4)节段1~2级椎间盘比例均显著减少,差异有统计学意义(P<0.05)。与正常组相比,肥胖组L_(3~4)节段4级、5级椎间盘比例均显著增加,差异有统计学意义(P<0.05)。L_(4~5)节段各组3级、4级、5级椎间盘,肥胖组分别为14例(21.9%)、28例(43.8%)、18例(28.1%),超重组分别为69例(56.1%)、31例(25.2%)、12例(9.8%),正常组分别为99例(69.7%)�Objective To explore the correlation and regulation between obesity and lumbar disc degeneration in the patients with low back and leg pain. Methods Three hundred and twenty-nine patients with low back and leg pain who visited our out-patient department of spinal surgery and were diagnosed with lumbar spinal stenosis or lumbar disc herniation from January 2014 to December 2015 were included. Demographic data were collected including height, weight, sex, age, history of high blood pressure, history of diabetes, history of smoking and occupation. The severity of back pain were graded using visual analogue scale（ VAS）. Body mass index（ BMI） was calculated according to weight and height. The patients were divided into normal group（ 18.5 kg / m^2 BMI 24.0 kg / m^2）, overweight group（ 24 kg / m^2 ≤ BMI 28 kg / m^2） and obese group（ BMI ≥ 28 kg / m^2） according to BMI. MRI examination was performed on all the patients, and lumbar discs were graded using the Pfirrmann grading system. The correlation and regulation between obesity and lumbar disc degeneration were statistically analyzed. Results There were 26（ 40.6%） patients who had a history of high blood pressure in obese group, 27（ 22.0%） in overweight group and 17（ 12.0%） in normal group. The prevalence of high blood pressure showed statistically significant differences between obese group and overweight group, obese group and normal group（ P〈0.05）. Other demographic data including sex, age, prevalence of diabetes, prevalence of smoking and occupation showed no statistically significant differences among the 3 groups（ P〉0.05）. In L（1-2） segment, the numbers of Pfirrmann 3 disc were 20（ 31.3%） in obese group, 33（ 26.8%） in overweight group and 26（ 18.3%） in normal group. Proportion of Pfirrmann 3 disc in L（1-2） segment was significantly higher in obese group than in normal group（ P〈0.05）. In L2-3 segment, proportions of disc numbers of each Pfirrmann grade showed no statistically significant dif

关 键 词：腰腿痛 椎间盘退行性变 腰椎 肥胖症 人体质量指数 

分 类 号：R681.5[医药卫生—骨科学]