L_(4、5)旁侧型腰椎间盘突出与腰椎关节突关节关系的临床分析  

Clinical analysis of relationship between L_(4、5) paracentral lumbar disc herniation and lumbar facet joints

作　　者：何克云[1] 胡朝晖[1] 胡巍 罗同青[1] HE Keyun;HU Zhaohui;HU Wei;LUO Tongqing(Department of Spinal Surgery,Liuzhou People's Hospital,Liuzhou,Guangxi 545006,China)

机构地区：[1]柳州市人民医院脊柱外科,广西545006

出　　处：《中国骨与关节损伤杂志》2024年第11期1136-1141,共6页Chinese Journal of Bone and Joint Injury

基　　金：广西卫健委自筹经费科研课题项目(Z20170659)。

摘　　要：目的分析L_(4、5)旁侧型椎间盘突出与腰椎关节突关节的关系。方法收集自2017-01-2022-01诊治的111例L_(4、5)单节段旁侧型腰椎间盘突出为A组,同时收集107例腰椎正常者为B组,所有研究对象分别由2名脊柱骨科医师各自独立在MRI片上测量L_(4、5)、L_(5)S_(1)双侧关节突关节角度,得出相应的角度测量值后交由第3位医师进行统计,相应关节突关节角度取前2位医师所提交测量值的平均值为关节突关节角度值,再计算相应的关节突角度和值及差值。采用单因素分析及多因素Logistic回归分析L4s旁侧型腰椎间盘突出的相关影响因素。结果两组在年龄、性别、体质量指数、L_(4、5)(∠C)、L_(5)S_(1)(∠C)、L_(5)S_(1)(|∠α-∠βI)、L_(5)S_(1)不对称、L_(4、5)与L_(5)S_(1)∠C差值绝对值、L_(4、5)与L_(5)S_(1)∠α差值绝对值方面差异均无统计学意义(P>0.05);但是A组L_(4、5)(|∠α-∠β|)明显大于B组,L_(4、5)不对称情况明显高于B组,L_(4、5)与_(4、5)∠β差值绝对值明显大于B组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,L_(4、5)(|∠α-∠βI)是_(4、5)旁侧型腰椎间盘突出的独立危险因素(OR=1.172,P<0.05)。ROC曲线分析结果显示,_(4、5)(|∠α-∠βI)对于L4.旁侧型腰椎间盘突出的发生具有一定预警意义,截断值为9.463。结论L_(4、5)旁侧型腰椎间盘突出与_(4、5)(|∠α-∠β|)具有相关性。在L_(4、5)双侧腰椎间盘突出角度差值较大的人群中,应更加注意避免对腰部的过度负荷,平时应该加强腰背肌的功能锻炼,增加肌肉的力量,增强对腰椎局部应力状态下的保护,预防腰椎间盘突出发生。Objective To analyze the association between L_(4、5)lateral disc herniation and lumbar facet joints.Methods Be-tween January 2017 and January 2022,a total of 111 cases of single-level paracentral lumbar disc herniation at the L_(4、5)level were collected and designated as group A.Concurrently,107 individuals with normal lumbar spines were assembled and desig-nated as group B.Each subject in both groups was independently assessed for bilateral facet joint angles at L_(4、5)and LS,using MRI imaging by two spinal orthopedic surgeons.The measurements obtained were submitted to a third physician for statistical analysis.The facet joint angles were calculated by averaging the values reported by the initial two surgeons.Thereafter,the mean facet angles and their differences were determined.Both univariate and multivariate Logistic regression analyses were con-ducted to identify the influencing factors associated with paracentral lumbar disc herniation at the L_(4、5)level.ResultsT There were no statistically significant differences between the two groups in terms of age,gender,body mass index,L_(4、5)S_(1)(∠C),L_(5)S_(1),the absolute difference in L_(5)S_(1)(|∠α-∠β|),L_(5)S_(1),asymmetry,the absolute dfference in L_(4、5)and L_(5)S_(1) ∠C,and the absolute difference in L_(4、5) and L_(5)S_(1)∠α(P>0.05).However,group A had a significantly larger L_(4、5)(|∠α-∠β|)compared to group B,with a higher incidence of L_(4、5) asymmetry and a significantly larger absolute difference in L_(4、5)and L_(4、5) β,all of which were statisti-cally significant(P<0.05).The results of the multivariate Logistic regression analysis indicated that L_(4、5)(|∠α-∠β|)was an inde-pendent risk factor for paracentral lumbar disc herniation at L_(4、5)(OR=1.172,P<0.05).The ROC curve analysis revealed that L_(5)S_(1),(|∠α-∠β|)had certain predictive value for the occurrence of paracentral lumbar disc herniation at L_(4、5),with a cutoff value of 9.463°.Conclusion Paracentral lumbar disc herniation at L_(4

关 键 词：腰椎间盘突出症 旁侧型突出 腰椎关节突关节 

分 类 号：R681.5[医药卫生—骨科学]