脊柱力学失衡与强直性脊柱炎胸背痛相关性研究  

Study on the correlation of spinal mechanics imbalance and thoraco-dorsal pain in ankylosing spondylitis

作　　者：李敏[1] 梁翼[1] 吴晓惠[1] 余文景[1] 伊伟恩 马全 耿云龙 刘碧莹 周文琪[4] 张挥武 Li Min;Liang Yi;Wu Xiaohui;Yu Wenjing;Yi Weien;Ma Quan;Geng Yunlong;Liu Biying;Zhou Wenqi;Zhang Huiwu(Department of Rheumatology, Sichuan Orthopedic Hospital, Chengdu 610041, China;Department of Rehabilitation, Yuechi County Hospital of Guang'an, Sichuan 638300, China;Sports Medicine, Chengdu Institute of Physical Education, Sichuan 610043, China;Functional Laboratory of State Administration of Traditional Chinese Medicine, Chengdu 610041, China)

机构地区：[1]四川省骨科医院风湿骨关节病科,成都610041 [2]四川省广安市岳池县中医医院康复科,638300 [3]成都体育学院运动医学系,610043 [4]四川省骨科医院国家中医药管理局重点机能实验室,成都610041

出　　处：《中华风湿病学杂志》2019年第3期170-174,共5页Chinese Journal of Rheumatology

基　　金：四川省中医药管理局资助项目(2018LC025);成都中医药大学校基金(YYZX1708).

摘　　要：目的探讨脊柱力学失衡与AS胸背痛的相关性。方法收集我院AS患者90例,根据入组时是否伴有胸背痛疼分为胸背痛AS组(30例)和无胸背痛AS组(60例),分别收集其临床症状,BASDAI、BASFI、Bath强直性脊柱炎衡量指数(BASMI)、强直性脊柱炎疾病活动度(ASDAS),并同期检测其脊柱力学功能、核心肌力测试,采用t检验,方差分析比较组间的差异,以及Spearman相关分析探讨其胸背痛发生与临床评分及脊柱力学指标的相关性。结果①胸背痛AS组与无胸背痛AS组在背部肌力时间比较中差异有统计学意义[(0.82±0.41)min与(1.33±0.74)min,F=12.372,P=0.001];②胸背痛AS组多以中下段胸椎病变为主,MRI漏诊率较高,尤以肋头与肋横突炎、面关节炎、棘上韧带炎等微小病变为主;③健康对照组在前屈力量对比中与AS组差异有统计学意义[(92.1±46.3)Nm与(126.6±35.7)Nm,F=6.440,P=0.002];④在脊柱左右旋转比较中,胸背痛AS组与无胸背痛AS组差异有统计学意义[(1.18±0.22)与(1.05±0.17),F=10.044,P<0.01];⑤胸背痛AS患者组其脊柱左右旋转与BASDAI有关(r=-0.522,P=0.004);与脊柱活动度向右侧屈(r=0.435,P=0.021),向左侧屈(r=0.528,P=0.004)有关;与脊柱力量向左旋转(r=0.57,P=0.001),向右侧屈(r=0.368,P=0.049),向左侧屈(r=0.369,P=0.049)有关。结论AS胸背痛以中下段胸椎为主,MRI漏诊率高,且脊柱左右侧力学失衡是AS胸背痛的相关因素之一。Objective To investigate the correlation of spinal mechanical imbalance and thoraco-dorsal pain of ankylosing spondylitis(AS). Methods The clinical data of 90 patients with AS were collected. Patients were divided into two groups according to the presence of thoracodorsal pain: the AS with thoraco-dorsal pain group (30 cases) and the AS without thoraco-dorsal pain group (60 cases). Clinical symptoms, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis function index (BASFI), Bath ankylosing spondylitis measurement index (BASMI), ankylosing spondylitis disease activity (ASDAS), and spinal mechanical function and nuclear myocardial force test were compared using t-test, one-way analysis of variance (ANOVA) analysis and Spearman correlation analysis. Results ① There were differences between thoraco-dorsal pain group and patients without thoracodorsal pain group at the time of back muscle strength[(0.82±0.41) min vs (1.33±0.74) min, F=12.372, P=0.001];② Thoraco-dorsal pain in the AS group was mainly the middle and lower thoracic vertebrae, such as the inflammation of rib head and rib transverse process, facial arthritis, and spinous ligaments, etc. And the missed diagnosis rate of magnetic resonance imagin (MRI) was high.③ In healthy control group, the anterior flexion strength of thoracodorsal pain group was signific-antly different from that of patients without thoracodorsal pain [(92.1±46.3) Nm vs (126.6±35.7) Nm, F=6.440, P=0.002].④ There was significant difference in spinal strength as well as left and right rotation strength between the thoracodorsal pain group and patients without thoracodorsal pain [(1.18±0.22) vs (1.05±0.17), F=10.044, P<0.01];⑤ In the thoraco-dorsal pain group, the right/left index was related to BASDAI (r=-0.522, P=0.004). For spinal mobility, the right/left index was related to cross cutting faces to right (r=0.435, P=0.021), cross cutting faces to left (r=0.528, P=0.004). In spinal strength, the right/left index was related to left tur

关 键 词：脊柱炎 强直性 力学 肌力 胸椎 

分 类 号：R593.23[医药卫生—内科学]