腰椎间盘退行性变患者椎间盘高度指数与Pfirrmann分级的相关性  

Correlation between disc height index and Pfirrmann grade in patients with lumbar disc degeneration

作　　者：樊鑫宇 罗智略 廖晓龙 柯广水 胡浪 邹峰 加英豪 胡嘉倡 徐俊昌 FAN Xinyu;LUO Zhilue;LIAO Xiaolong;KE Guangshui;HU Lang;ZOU Feng;JIA Yinghao;HU Jiachang;XU Junchang(Department of Orthopedics,the First People's Hospital of Xiangyang Affiliated to Hubei University of Medicine,Xiangyang,Hubei 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院骨科,湖北襄阳441000

出　　处：《中华实用诊断与治疗杂志》2025年第1期67-71,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省中医药管理局中医药科研项目(ZY2023F088);湖北医药学院研究生科技创新项目(YC2024043)。

摘　　要：目的 分析腰椎间盘退行性变患者椎间盘高度指数(DHI)与椎间盘Pfirrmann分级的关系,探讨其临床应用价值。方法 2021年10月—2022年10月湖北医药学院附属襄阳市第一人民医院94例因腰椎间盘突出、腰椎椎管狭窄症致腰痛的住院患者,均行腰椎CT、MRI检查,行Pfirrmann分级,测量L_(1-2)、L_(2-3)、L_(3-4)、L_(4-5)、L_(5)S_(1)椎间盘高度及其上下位椎体高度并计算各节段DHI,比较同节段不同Pfirrmann分级、同Pfirrmann分级不同节段的DHI。采用Spearman相关法分析各节段DHI与Pfirrmann分级的相关性;采用Pearson法分析年龄与DHI的相关性;分析各节段椎间盘重度退行性变的情况。结果 (1)94例患者470个腰椎节段中,Pfirrmann分级Ⅰ级27个、Ⅱ级118个、Ⅲ级164个、Ⅳ级115个、Ⅴ级46个。L_(1-2)节段Pfirrmann分级Ⅰ~Ⅴ级分别为5、41、25、20、3个,L_(2-3)节段分别为6、35、30、19、4个,L_(3-4)节段分别为5、20、43、22、4个,L_(4-5)节段分别为2、8、40、29、15个,L_(5)S_(1)节段分别为9、14、26、25、20个。(2)Pfirrmann分级相同的所有节段的DHI比较差异均有统计学意义(F=6.760~152.840,P均<0.001)。L_(2-3)、L_(3-4)、L_(4-5)、L_(5)S_(1)节段不同Pfirrmann分级间DHI比较差异均有统计学意义(F=7.810~36.460,P均<0.001),L_(1-2)节段不同Pfirrmann分级间DHI比较差异无统计学意义(F=1.540,P=0.200)。(3)L_(1-2)、L_(2-3)、L_(3-4)、L_(4-5)、L_(5)S_(1)节段的DHI分别为0.12±0.03、0.14±0.03、0.15±0.03、0.15±0.05、0.28±0.10,与Pfirrmann分级均呈负相关(r=-0.22,P=0.03;r=-0.22,P=0.04;r=-0.43,P<0.001;r=-0.77,P<0.001;r=-0.73,P<0.001)。年龄与DHI无相关性(r=-0.027,P=0.500)。(4)L_(1-2)、L_(2-3)、L_(3-4)、L_(4-5)、L_(5)S_(1)椎间盘重度退行性变数量逐渐增多。结论 DHI可反映腰椎间盘退行性变的程度,DHI越小椎间盘退变程度越严重,且DHI与年龄无明显相关性。Objective To analyze the relationship between disc height index(DHI)and Pfirrmann grade in patients with lumbar disc degeneration,and to investigate its clinical application value.Methods Ninety-four patients with low back pain caused by lumbar disc herniation or lumbar spinal stenosis were hospitalized in the First People's Hospital of Xiangyang Affiliated to Hubei University of Medicine from October 2021to October 2022.All patients received lumbar spine CT and MRI examinations,and Pfirrmann grading.The heights of L_(1-2),L_(2-3),L_(3-4),L_(4-5)and L_(5)S_(1)intervertebral discs and the upper and lower vertebral body heights were measured,and the DHI of each segment was calculated.The DHIs were compared among the same segment with different Pfirrmann grades and among the different segments with same Pfirrmann grade.The Spearman correlation method was used to analyze the correlation between DHI and Pfirrmann grade in each segment.The Pearson method was used to analyze the correlation between age and DHI.The severe degeneration of intervertebral discs in each segment was analyzed.Results(1)Out of 470lumbar segments in 94patients,there were 27segments at Pfirrmann gradeⅠ,118at gradeⅡ,164at gradeⅢ,115at gradeⅣ,and 46at gradeⅤ.At Pfirrmann gradeⅠ-Ⅴ,there were 5,41,25,20and 3L_(1-2)segments;6,35,30,19and 4L_(2-3)segments;5,20,43,22and 4 L_(3-4)segments;2,8,40,29and 15 L_(4-5)segments;9,14,26,25and 20 L_(5)S_(1)segments,respectively.(2)There were significant differences in DHIs among all segments at Pfirrmann gradeⅠ-Ⅴ(F=6.760-152.840,all Pvalues<0.001)and in DHIs at L_(2-3),L_(3-4),L_(4-5)and L_(5)S_(1)segments among Pfirrmann gradeⅠ-Ⅴ(F=7.810-36.460,all Pvalues<0.001),and there were no significant differences in DHIs at L_(1-2)segment among Pfirrmann gradeⅠ-Ⅴ(F=1.540,P=0.200).(3)The DHIs of L_(1-2),L_(2-3),L_(3-4),L_(4-5)and L_(5)S_(1)segments were 0.12±0.03,0.14±0.03,0.15±0.03,0.15±0.05and 0.28±0.10,respectively,and were negatively correlated with Pfirrmann grade(r=-0.22,P=0.03;r=-0.22,

关 键 词：腰椎间盘退行性变 椎间盘高度指数 Pfirrmann分级 相关性 

分 类 号：R681.53[医药卫生—骨科学]