脊柱功能单位构型改变在腰椎间盘突出症中的意义  

Configuration changes of functional spinal units in patients with lumbar disc herniation

作　　者：冯伟[1] 王飞[1] 许奎[1] FENG Wei;WANG Fei;XU Kui(Department of TCM Manipulative Orthopedics,Air Force General Hospital,Beijing 100142,China)

机构地区：[1]空军总医院中西医结合正骨治疗科,北京100142

出　　处：《空军医学杂志》2018年第3期196-198,共3页Medical Journal of Air Force

基　　金：空军总医院课题(kz2015031)

摘　　要：目的初步研究脊柱功能单位构型改变在腰椎间盘突出症中意义。方法采用脊柱(定点)旋转复位法治疗腰椎间盘突出症Ⅲ、Ⅳ型共30例,治疗前后应用Adobe Photoshop记录并测量患侧下肢直腿抬高角度。治疗前后进行腰椎MRI扫描主要观察指标:突出间盘节段,突出类型,与神经根位置关系;突出节段脊柱功能单位构型;腰椎(骨盆)旋转侧弯代偿形式;椎间盘矢状径指数(SI)。结果推测腰椎(骨盆)旋转侧弯代偿可能受到突出节段脊柱功能单位构型改变的制约。患侧直腿抬高治疗后提高(P=0.000)。脊柱功能单位构型治疗前后有改变(P=0.000),椎间盘矢状径指数治疗前后差异无统计学意义(P=0.121)。结论突出椎间盘不是腰椎间盘突出症患者临床表现的决定因素。单(多)个椎体位移,造成脊柱功能单位构型改变,相邻椎体、突出的间盘形成共同体对神经根造成压迫或牵扯。Objective To investigate configuration changes of functional spinal units（FSUs） in patients with prolapse of lumbar intervertebral disc. Methods Thirty patients with prolapse of lumbar intervertebral disc（type Ⅲ or Ⅳ, according to the standards for lumbar malformation devised by Feng Tianyou） were treated by spinal fixedpoint rotating reduction. Straight leg raising（SLR）was measured with software Adobe Photoshop in body pictures before and after treatment. Three dimensional MRI was performed before and after treatment to observe the protruded segments, relationships between the nucleus pulposus and nerve roots involved, configuration changes of FSUs of protruded segments, lumbar（pelvic） malformation due to compensation and the sagittal index（SI） of the protruded disc. Results Lumbar（pelvic） malformation of rotation and lateral bending may be related to configuration changes of FSUs of protruded segments. SLR was increased significantly after treatment（P=0.000）, so was configuration of FSUs （P=0.000）. There was no significant change in the SI after treatment（P=0.121）. Conclusion The protruded disc may not be the determinant of clinical manifestations of prolapse of lumbar intervertebral disc in patients. Single（multiple） vertebral displacement leads to configuration changes of FSUs（combination of adjacent vertebrae and the protruded disc）,and causes stress or irritation to nerve roots involved.

关 键 词：腰椎间盘突出症 脊柱功能单位构型 椎体位移 脊柱(定点)旋转复位法 

分 类 号：R658[医药卫生—外科学]