脊柱神经高张力与椎间盘退变相关性分析  

Analysis of correlation between spinal nerve high tension and disc degeneration in 100 cases

作　　者：孔庆捷[1] 徐锡明[1] 孙璟川[1] 王元[1] 史国栋[1] 郭永飞[1] 杨海松[1] 杨勇[1] 史建刚[1] 

机构地区：[1]第二军医大学附属长征医院脊柱外科,上海200433

出　　处：《中华医学杂志》2017年第43期3416-3420,共5页National Medical Journal of China

摘　　要：目的探索腰椎间盘退变与神经高张力之间的相关性及自缢性椎间盘退变的新型发病机制。方法回顾性分析2016年6月至2017年6月第二军医大学附属长征医院脊柱外科因腰椎管狭窄症收治的100例患者的腰椎MRI资料，根据术前腰椎MRI马尾神经沉降征及术中探测神经张力结果将其分为试验组（50例，神经高张力组）、对照组（50例，神经张力正常组），用Pfirrmann分级对每例患者腰椎节段（L3／4-L5／S1）的椎间盘退变程度进行分级，分析神经高张力与腰椎间盘退变的相关性，并比较试验组与对照组腰椎间盘退变的严重程度。结果两组患者的年龄、性别比差异无统计学意义（P〉0．05）。试验组Pfirrmann分级IJ3／4为（4．74±1．6）级，IA／5为（5．32±1．33）级，15／s1为（5．54±1．13）级；对照组Pfirrmann分级13／4为（3．5±1．16）级，L4／5为（4．12±0．9）级，L5／S1为（4．1±0．97）级。试验组的椎间盘退变严重程度大于对照组（P〈0．05）。L3／4、L4／5、L5／S1的腰椎间盘退变与神经高张力之间均存在相关性，且相关性趋势为L5／S1〉L4／5〉L3／4。结论腰椎间盘退变与神级高张力存在相关性，初步提出自缢性椎间盘退变的新型发病机制，即腰椎间盘退变是为了缓解神经受到的轴向牵拉损伤而自发的代偿性保护机制。Objective To explore the correlation between the spinal nerve high tension and lumbar disc degeneration, the pathogenesis of hanging intervertebral disc degeneration. Methods From June 2016 to June , a retrospective analysis 2017 of 100 cases of lumbar spinal stenosis were included in Department of Spine Surgery, Changzheng Hospital, the Second Military Medical University. They were divided into experimental group （50 cases, nerve high tension group） and control group （50 cases, nervous tension in the nmral group） according to preoperative lumbar MRI of cauda equina syndrome and settlement of intraoperative detecting nerve tension. The Pfirrmann grade was used to evaluate degree of lumbar （ L3/4 - LS/S1 ） disc degeneration. The correlation between spinal nerve tension and lumbar disc degeneration was analyzed, and the severity of experimental group and control group on lumbar disc degeneration was compared. Results There was no significant difference in the age and sex ratio between the two groups （P 〉0. 05）. The Pfirrmann score of the experimental group was L3/4 （4.74 ± 1.6） grade, IA/5 （5.32 ± 1.33） grade, L5/S1 （5.54 ± 1.13） grade; the control group Pfirrmann score was L3/4 （3.5 ±1.16） grade, IA/5 （ 4. 12 ± 0.9 ） grade, and LS/S1 （ 4. 1 ± O. 97 ） grade. The severity of intervertebral disc degeneration in experimental group was higher than that in control group, with statistical significance （ P 〈 O. 05 ）. There was a correlation between lumbar disc degeneration and nerve tension in L3/4, L4/5 and LS/ S1, and the correlation trend was LS/S1 〉 IA/5 〉 I3/4. Conclusion There is a correlation between lumbar disc degeneration and spinal nerve high tension. A new pathogenesis of hanging intervertebral disc degeneration that the degeneration of lumbar disc is a compensatory mechanism in order to alleviate the axial stretch injury is put forward.

关 键 词：腰椎间盘退变 神经高张力 腰骶神经弓弦病 邻椎病 脊柱侧弯 

分 类 号：R681.5[医药卫生—骨科学]