L_(5)/S_(1)椎间盘突出重吸收的腰骶矢状面参数改变  

Changes in lumbosacral sagittal plane parameters of L5/S1 disc herniation reabsorption

作　　者：何心愉 周红海[1,2,3] 姜宏 马智佳[4] 苏少亭 林泽宏 田君明 陈龙豪[1,2,3] 刘柏杰 He Xinyu;Zhou Honghai;Jiang Hong;Ma Zhijia;Su Shaoting;Lin Zehong;Tian Junming;Chen Longhao;Liu Baijie(College of Orthopedics and Traumatology,Guangxi University of Chinese Medicine,Nanning 530001,Guangxi Zhuang Autonomous Region,China;Guangxi Key Laboratory of Biomechanics and Injury Repair in Traditional Chinese Medicine Orthopedics and Traumatology,Nanning 530001,Guangxi Zhuang Autonomous Region,China;Research Center for the Inheritance and Development of Academic Thought and Clinical Diagnosis and Treatment by Master of Chinese Medicine Wei Guikang,Nanning 530001,Guangxi Zhuang Autonomous Region,China;Suzhou Traditional Chinese Medicine Hospital,Suzhou 215007,Jiangsu Province,China)

机构地区：[1]广西中医药大学骨伤学院,广西壮族自治区南宁市530001 [2]广西中医骨伤科生物力学与损伤修复重点实验室,广西壮族自治区南宁市530001 [3]国医大师韦贵康学术思想与临床诊疗传承发展研究中心,广西壮族自治区南宁市530001 [4]苏州市中医医院,江苏省苏州市215007

出　　处：《中国组织工程研究》2024年第9期1330-1335,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金地区基金资助项目(81360552,81660800),项目负责人:周红海;广西中医药大学桂派中医药传承创新团队资助项目(2022V001),项目负责人:周红海。

摘　　要：背景:以往有研究表明了腰骶矢状面参数与腰椎间盘突出重吸收现象的相关性,但腰骶矢状面参数包括了腰椎前凸角、腰骶关节角、骶骨倾斜角等众多参数,且各参数对椎间盘重吸收的影响具有差异性;另外目前对具体某一节段椎间盘突出重吸收的研究尚少,测量数据也多从数字化X射线摄影或CT中获取,而从MRI中测量的腰骶矢状面参数与L_(5)/S_(1)椎间盘突出后发生重吸收的相关性报道则较少见。目的:观察L_(5)/S_(1)椎间盘突出重吸收后腰椎矢状面参数的相应改变,筛选出椎间盘重吸收过程中变化最显著的腰骶矢状面参数。方法:选择具有完整MRI影像资料的57例腰椎间盘突出症患者,符合腰椎间盘突出症诊断标准,且单纯接受非手术治疗L_(5)/S_(1)突出节段发生重吸收现象。MRI测量冠状面上的最大突出层面的突出面积、腰骶矢状面参数,包括腰椎曲线指数、腰椎前凸角(α)、L_(5)/S_(1)椎间盘角(β)、椎间隙高度、腰骶关节角、骶骨平台角、骶骨倾斜角、下腰椎前凸角,将腰骶矢状面参数在R软件中采用随机森林模型进行变量重要性排序,再将显著的变量进行多元线性回归拟合,并通过配对样本t检验分析治疗前后各参数之间的变化。结果与结论:①共计57例L_(5)/S_(1)腰椎间盘突出症患者纳入研究,患者症状及影像学特征都在很大程度上较治疗前明显缓解;②治疗前的美国密歇根州立大学(MSU)分型为1级4例,2级29例,3级24例,经治疗后变为1级48例,2级9例;③随机森林模型提示椎间隙高度、腰椎曲线指数、骶骨倾斜角、下腰椎前凸角在L_(5)/S_(1)椎间盘突出重吸收中变化显著,而其变化显著性排序为腰椎曲线指数>椎间隙高度>骶骨倾斜角>下腰椎前凸角;④治疗后的腰椎曲线指数、腰椎前凸角、骶骨平台角较治疗前增大,差异均有显著性意义(P<0.05);椎间盘角、椎间隙高度、下腰椎前凸角�BACKGROUND:Previous studies have shown the correlation between lumbosacral sagittal plane parameters and natural absorption of lumbar disc herniation.However,the lumbosacral sagittal plane parameters included lumbar lordosis angle,lumbosacral joint angle,sacral inclination angle and many other parameters.The effects of each parameter on the natural absorption of the herniated disc were different.In addition,there are few studies on the reabsorption of a specific segment of intervertebral disc herniation at present,and most of the measured data are obtained from digital radiography or CT,while the correlation between lumbosacral sagittal plane parameters measured from MRI and reabsorption after L_(5)/S_(1)intervertebral disc herniation is rarely reported.OBJECTIVE:To study the corresponding changes of lumbar sagittal plane parameters after L_(5)/S_(1)intervertebral disc herniation reabsorption and to screen out the lumbosacral sagittal plane parameters with the most significant changes during intervertebral disc reabsorption.METHODS:Totally 57 patients with lumbar disc herniation who had complete MRI image data were selected and met the diagnostic criteria for lumbar disc herniation and only received non-surgical treatment for reabsorption of L_(5)/S_(1)protrusion segments.MRI measured the protrusion area of the maximum protrusion plane in the coronal plane,lumbosacral sagittal plane parameters[lumbar curvature index,lumbar lordosis(α),L_(5)/S_(1)disc angle(β),intervertebral height measurement,lumbosacral joint angle,sacral platform angle,sacral inclination angle,and lower lumbar lordosis angle].Besides,lumbosacral sagittal plane parameters were ranked in the importance of variables by random forest model in R software,and then significant variables were fitted with multiple linear regression.The changes between parameters before and after treatment were analyzed and compared by paired sample t-test.RESULTS AND CONCLUSION:(1)A total of 57 patients with L_(5)/S_(1)lumbar disc herniation were included in this stud

关 键 词：随机森林算法 腰椎间盘突出症 重吸收 腰骶矢状面参数 腰椎曲度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R445.2