高位腰椎间盘突出症矢状面相关因素分析  

Sagittal related factors of upper lumbar disc herniation

作　　者：袁海波 李东亚 潘彬 管凯 陈风 袁峰 吴继彬 Yuan Haibo;Li Dongya;Pan Bin;Guan Kai;Chen Feng;Yuan Feng;Wu Jibin(Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Orthopedics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学,江苏省徐州市221000 [2]徐州医科大学附属医院骨科,江苏省徐州市221000

出　　处：《中国组织工程研究》2023年第31期4984-4989,共6页Chinese Journal of Tissue Engineering Research

基　　金：徐州市2021年推动科技创新专项资金(KC21177),项目负责人:潘彬;徐州医科大学附属医院临床重点专科经费-2019医疗新技术经费(2019301024),项目负责人:吴继彬,袁峰。

摘　　要：背景:高位腰椎间盘突出症相比于常见节段的腰椎间盘突出症少见,但是高位椎管内结构复杂,因而临床表现常较严重且变化多样,分析相关影像学参数可以更深入地了解疾病特点,为早期诊疗及患者术后预防复发提供思路。目的:分析高位腰椎间盘突出症患者矢状面相关影像学参数特点,探讨不同参数对于高位腰椎间盘突出症发病的可能影响。方法:收集2019年1月至2022年1月住院治疗的高位腰椎间盘突出症患者46例作为观察组,其中L_(1)-L_(2)节段椎间盘突出9例,L_(2)-L_(3)节段10例,L_(3)-L_(4)节段27例。按照1∶1比例选取同时期因L_(4)-L5节段腰椎间盘突出症就诊的46例患者为对照组。在站立位腰椎正侧位X射线片上测量两组患者的矢状面影像学参数,包括骨盆倾斜角、骨盆入射角、骶骨倾斜角、腰椎前凸角、胸腰椎后凸角、楔形椎骨角度。使用多因素Logistic回归分析判断上述参数与高位腰椎间盘突出症发病的相关性,对有意义的结果进一步纳入ROC曲线分析危险因素的影响效应。结果与结论:①观察组患者的骨盆倾斜角、骨盆入射角、骶骨倾斜角、腰椎前凸角明显小于对照组(P<0.05);而观察组的胸腰椎后凸角、楔形椎骨角度均大于对照组(P<0.05)。②多因素Logistic回归分析显示胸腰椎后凸角过大(OR=1.963,95%CI:1.341-2.874,P=0.001)以及楔形椎骨角度较大(OR=1.635,95%CI:1.069-2.499,P=0.023)影响高位腰椎间盘突出症的发病。而骨盆倾斜角、骨盆入射角、骶骨倾斜角、腰椎前凸角等指标在两组之间的差异虽然具有统计学意义,但是并不能作为独立的危险因素。③ROC曲线分析结果显示胸腰椎后凸角、楔形椎骨角度对于高位腰椎间盘突出症的发生具有一定预警意义,两者的截断值分别为10.45°,6.45°。④结果表明,腰椎正侧位片可以较好地评估高位腰椎间盘突出症患者矢状位相关参数,高位腰椎间BACKGROUND:Compared with the common segment of lumbar disc herniation,upper lumbar disc herniation is rare,but the structure of the high spinal canal is complex,so the clinical manifestations are often serious and varied.Analysis of related imaging parameters can provide a deep understanding of the disease characteristics,and provide ideas for early diagnosis and treatment and postoperative prevention of recurrence.OBJECTIVE:To analyze the characteristics of sagittal imaging parameters in patients with upper lumbar disc herniation,and to explore the possible influence of different parameters on the incidence of upper lumbar disc herniation.METHODS:A total of 46 upper lumbar disc herniation patients hospitalized from January 2019 to January 2022 were collected as the observation group,including 9 cases of disc herniation at the L_(1)-L_(2) level,10 cases at the L_(2)-L_(3) level,and 27 cases at the L_(3)-L_(4) level.According to the 1∶1 ratio,46 patients with L_(4)-L5 lumbar disc herniation during the same period were selected as the control group.Sagittal imaging parameters of the two groups were measured on the anteroposterior and lateral lumbar X-ray films in standing position,including:pelvic tilt,pelvic incidence,sacral slope,lumbar lordosis,thoracolumbar kyphosis,and wedging angle of the vertebrae.Multivariate Logistic regression analysis was used to determine the correlation between the above parameters and the incidence of upper lumbar disc herniation,and receiver operating characteristic curve was used to analyze the influence of risk factors for meaningful results.RESULTS AND CONCLUSION:(1)Pelvic tilt,pelvic incidence,sacral slope,and lumbar lordosis of the observation group were significantly less than those in the control group(P<0.05).Thoracolumbar kyphosis and wedging angle of the vertebrae in the observation group were larger than those in the control group(P<0.05).(2)Multivariate Logistic regression analysis showed that high thoracolumbar kyphosis(OR=1.963,95%CI:1.341-2.874,P=0.001)and high wedgi

关 键 词：高位腰椎间盘突出症 脊柱-骨盆矢状面参数 楔形椎骨角度 影像学表现 解剖危险因素 ROC曲线 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681.5