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[1]張強華,何守玉,李海東,等.成人退變性腰椎側凸可矯正程度與側凸節(jié)段椎間盤退變程度的相關性分析[J].中醫(yī)正骨,2019,31(04):17-21.
　ZHANG Qianghua,HE Shouyu,LI Haidong,et al.A correlation analysis of the relationship between corrigible degree of degenerative lumbar scoliosis and degeneration degree of intervertebral disc at scoliosis segments in adults[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(04):17-21.
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成人退變性腰椎側凸可矯正程度與側凸節(jié)段椎間盤退變程度的相關性分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數:
2019年04期
頁碼:
17-21
欄目:
臨床研究
出版日期:
2019-04-30

文章信息/Info

Title:
A correlation analysis of the relationship between corrigible degree of degenerative lumbar scoliosis and degeneration degree of intervertebral disc at scoliosis segments in adults
作者:
張強華; 何守玉; 李海東; 閔繼康
(湖州師范學院附屬第一醫(yī)院,浙江 湖州 313000)
Author(s):
ZHANG Qianghua; HE Shouyu; LI Haidong; MIN Jikang
The First Affiliated Hospital of Huzhou Normal University,Huzhou 313000,Zhejiang,China
關鍵詞:
脊柱側凸;  腰椎;  椎間盤退行性變;  矯形外科手術
Keywords:
scoliosis;  lumbar vertebrae;  intervertebral disc degeneration;  orthopedic procedures
摘要:
目的:探討成人退變性腰椎側凸(degenerative lumbar scoliosis,DLS)可矯正程度與側凸節(jié)段椎間盤退變程度的相關性。方法:以2014年6月至2017年12月收治的成人DLS患者為研究對象。在患者術前拍攝的站立位全脊柱正位X線片、側屈位X線片及胸腰椎MRI上評定主彎區(qū)域的椎間盤退變程度和可矯正程度。評定范圍包括主彎區(qū)域側凸頂部節(jié)段(apical vertebrae,AV),側凸頂部上、下一節(jié)段(AV+1、AV-1),側凸頂部椎間盤上、下兩節(jié)段(AV+2、AV-2)。分別在站立位全脊柱正位X線片和側屈位X線片上測量主彎Cobb角和椎間角,并以此計算脊柱柔韌性,間接評估側凸可矯正程度。根據患者的MRI評價主彎區(qū)椎間盤的退變程度,依據Pfirrmann椎間盤退變分級標準進行分級,并按照等級進行評分(Ⅰ級為0分,Ⅱ級為1分,Ⅲ級為2分,Ⅳ級為3分,Ⅴ級為4分)。結果:研究共納入33例患者,男10例,女23例; 年齡55～72歲,中位數64歲。患者的站立位全脊柱正位X線片上的主彎Cobb角為30.4°±6.4°,側屈位X線片上的主彎Cobb角為18.5°±5.1°,主彎整體柔韌性為(39.20±9.30)%。主彎各節(jié)段的椎間盤退變程度評分比較,差異有統(tǒng)計學意義[AV+2:(2.10±0.62)分,AV+1:(3.01±0.59)分,AV:(4.11±0.69)分,AV-1:(3.14±0.81)分,AV-2:(2.90±0.71)分,F=8.118,P=0.010]; AV節(jié)段椎間盤退變程度評分高于其他節(jié)段(P=0.001; P=0.012; P=0.001; P=0.017)。主彎各節(jié)段的柔韌性比較,差異有統(tǒng)計學意義[AV+2:(56.08±13.52)%,AV+1:(40.61±10.63)%,AV:(30.30±8.22)%,AV-1:(45.11±11.17)%,AV-2:(60.08±12.10)%,F=9.104,P=0.007]; AV節(jié)段的柔韌性低于其他節(jié)段(P=0.001; P=0.000; P=0.000; P=0.001)。主彎各節(jié)段的椎間盤退變評分與對應節(jié)段的柔韌性均呈負相關(AV+2:r=-0.713,P=0.001; AV+1:r=-0.623,P=0.000; AV:r=-0.899,P=0.000; AV-1:r=-0.683,P=0.001; AV-2:r=-0.603,P=0.002)。結論:成人DLS患者主彎各節(jié)段的椎間盤均存在不同程度的退行性改變,側凸頂部椎間盤退變程度最高、可矯正程度最差,側凸各節(jié)段的可矯正程度與相應節(jié)段的椎間盤退變程度均呈負相關。
Abstract:
Objective:To explore the correlation between corrigible degree of degenerative lumbar scoliosis(DLS)and degeneration degree of intervertebral disc at scoliosis segments in adults.Methods:The adults with DLS recruited from June 2014 to December 2017 were selected as the subjects.The degeneration degree of intervertebral disc and corrigible degree of DLS of main bending section were evaluated using the whole spine anteroposterior X-ray films in standing position and lateral flexion position and thoracic-lumbar MRI that were taken before surgery.The evaluation scopes covered apical vertebrae(AV),AV+1,AV-1,AV+2 and AV-2 of main bending section.The Cobb angle and intervertebral angle of the main bending section were measured on the whole spine anteroposterior X-ray films in standing position and lateral flexion position respectively,and the spinal flexibility was evaluated according to the final measurement results,and the corrigible degree of scoliosis was assessed indirectly.The degeneration degree of intervertebral disc of main bending section was evaluated and classified according to patients'MRI and Pfirrmann grading standards for intervertebral disc degeneration respectively,and it was scored according to the grade(0 point for gradeⅠ,1 point for gradeⅡ,2 points for gradeⅢ,3 points for gradeⅣand 4 points for gradeⅤ).Results:Thirty-three patients(10 males and 23 females)between the ages of 55 and 72(Median=64 yrs)were included in the study.The Cobb angles of the main bending section on the whole spine anteroposterior X-ray films in standing position and lateral flexion position were 30.4+/-6.4 and 18.5+/-5.1 degrees respectively,and the general flexibility of the main bending section was 39.20+/-9.30%.There was statistical difference in the scores of degeneration degree of intervertebral disc between segments of main bending section(AV+2:2.10+/-0.62 points,AV+1:3.01+/-0.59 points,AV:4.11+/-0.69 points,AV-1:3.14+/-0.81 points,AV-2:2.90+/-0.71 points,F=8.118,P=0.010).The scores of degeneration degree of intervertebral disc were higher in AV segment compared to other segments(P=0.001; P=0.012; P=0.001; P=0.017).There was statistical difference in flexibility between segments of main bending section(AV+2:56.08+/-13.52%,AV+1:40.61+/-10.63%,AV:30.30+/-8.22%,AV-1:45.11+/-11.17%,AV-2:60.08+/-12.10%,F=9.104,P=0.007).The flexibility was poorer in AV segment compared to other segments(P=0.001; P=0.000; P=0.000; P=0.001).The scores of of degeneration degree of intervertebral disc were negatively correlated with the flexibility in each segment of main bending section(AV+2:r=-0.713,P=0.001; AV+1:r=-0.623,P=0.000; AV:r=-0.899,P=0.000; AV-1:r=-0.683,P=0.001; AV-2:r=-0.603,P=0.002).Conclusion:The degenerative changes of intervertebral disc at different degrees exist at each segment of main bending section in adults with DLS.The degeneration degree of intervertebral disc is highest and the corrigible degree is the lowest in AV segment.The corrigible degree is negatively correlated with degeneration degree of intervertebral disc in each segment of DLS.

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備注/Memo

備注/Memo:
基金項目:湖州市科技局公益性應用研究項目(2016GYB10) 通訊作者:何守玉 E-mail:[email protected](收稿日期:2019-01-19 本文編輯:李曉樂)
更新日期/Last Update: 2019-10-08