基于“筋出槽,骨错缝”理论探讨腰骶部结构的影像表现特点与非特异性腰痛关系的临床研究  

Exploring the relationship between imaging features of lumbosacral structure and non-specific low back pain based on the theory of tendon off-position and mild malposition of bone and joint

作　　者：雷腾飞 杜国庆[2] 李正言[2] 陈博[2] 王辉昊[2] 胡零三[2] 詹红生[2] LEI Tengfei;DU Guoqing;LI Zhengyan;CHEN Bo;WANG Huihao;HU Lingsan;ZHAN Hongsheng(Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shen-zhen 518010,Guangdong,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]深圳平乐骨伤科医院/深圳市坪山区中医院,广东深圳518010 [2]上海中医药大学附属曙光医院,上海201203

出　　处：《中医正骨》2024年第8期27-30,51,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81473702);上海市临床重点专科建设项目(shslczdzk03901);上海市2021高水平地方高效创新团队建设项目(沪教委人[2022]3号)。

摘　　要：目的:基于“筋出槽,骨错缝”理论探讨腰骶部结构的影像表现特点与非特异性腰痛的关系。方法:纳入60例非特异性腰痛患者(腰痛组)和43例健康志愿者(无腰痛组),拍摄受试者腰椎正侧位X线片和CT片。于腰椎正侧位X线片上分别测量腰骶角、冠状面横骶径、冠状面横髂径,于腰椎横断位CT片上测量横断面横髂径;并分别计算冠状面横骶径、冠状面横髂径、横断面横髂径的相对值[(右侧径值-左侧径值)/右侧径值×100%]。于腰椎横断位CT片上,采用切线平行法判断L_(5)椎体是否旋转。比较2组受试者的腰骶角、L_(5)椎体旋转发生率,以及冠状面横骶径、冠状面横髂径、横断面横髂径的相对值。将冠状面横骶径、冠状面横髂径、横断面横髂径相对值<-5%定义为左侧相对偏长,将相对值>5%定义为右侧相对偏长,将-5%≤相对值≤5%定义为两侧基本对称。将腰痛组患者按照左侧疼痛、右侧疼痛及双侧疼痛划分,比较不同疼痛侧别患者的腰骶部影像学指标的对称性。结果:腰痛组患者腰骶角小于无腰痛组(t=2.458,P=0.016),冠状面横髂径相对值大于无腰痛组(Z=-2.288,P=0.022),L_(5)椎体旋转发生率高于无腰痛组(χ^(2)=5.589,P=0.018);2组受试者冠状面横骶径相对值、横断面横髂径相对值的组间比较,差异均无统计学意义(Z=-1.508,P=0.132;Z=-1.817,P=0.069)。腰痛组不同疼痛侧别患者的横断面横髂径对称性比较,差异有统计学意义(χ^(2)=9.309,P=0.011),冠状面横骶径、冠状面横髂径对称性的比较,差异无统计学意义(χ^(2)=0.512,P=0.473;χ^(2)=5.367,P=0.372)。结论:腰骶角变小、L_(5)椎体旋转、冠状面横髂径相对值增大与非特异性腰痛有关,且横断面横髂径对称性与腰痛侧别有关。这些影像表现特点可能是非特异性腰痛患者腰骶部结构“筋出槽,骨错缝”的影像学证据。Objective:To explore the relationship between imaging features of lumbosacral structure and non-specific low back pain(NSLBP)based on the theory of tendon off-position and mild malposition of bone and joint.Methods:Sixty NSLBP patients(LBP group)and 43 healthy volunteers(non-LBP group)were enrolled in the study,and their anteroposterior and lateral X-ray and CT films of lumbar spine were taken.The lumbosacral angle,coronal distance between transverse process and sacrum,and coronal distance between transverse process and ilium were measured on the anteroposterior and lateral X-ray films of lumbar spine,and the cross-sectional distance between transverse process and ilium was measured on the transverse CT films of lumbar spine.The relative values(ratio of difference between right distance and left distance to the right distance)of coronal distance between transverse process and sacrum,coronal distance between transverse process and ilium,and cross-sectional distance between transverse process and ilium were calculated,respectively;besides,the parallel tangent method was employed to determine whether the L_(5)vertebra was rotated on the transverse CT films of lumbar spine.The lumbosacral angle,incidence of rotation in L_(5)vertebra,and the relative values of coronal distance between transverse process and sacrum,coronal distance between transverse process and ilium,and cross-sectional distance between transverse process and ilium were compared between the two groups.The relative values of above-mentioned indicators of<-5%,>5%,and between-5%and 5%were defined as left-sided elongation,right-sided elongation,and bilateral symmetry,respectively.The patients with LBP were classified into 3 subgroups based on left-side pain,right-side pain,and bilateral pain,and the symmetry of imaging indicators in the lumbosacral region was compared among the different subgroups.Results:The lumbosacral angle was smaller(t=2.458,P=0.016),the relative values of coronal distance between transverse process and ilium was larger(Z=-2.288,P=0.

关 键 词：腰痛 腰骶部 筋出槽 骨错缝 影像表现特点 放射摄影术 体层摄影术 X线计算机 

分 类 号：R681.5[医药卫生—骨科学]