胸椎间盘突出症患者病变节段分布及其生物力学变化:57例临床资料及10年国内文献数据比较

Lesion segmental distribution and its biomechanical changes in patients with thoracic disc herniations: comparison between the clinical materials of 57 cases and the domestic document data in the past 10 years

目的:了解胸椎间盘突出症 ( thoracic disc herniations,TDH )的病变节段分布特点以及生物力学变化特征,探讨与 TD H 相关的可能发病因素。方法: 分析一组 57例 TDH 患者的病变脊柱节段分布特点。临床资料 ①的时间范围为 1994-01/2002-12 ②将本组临床资料与近 10年在国 。内期刊上发表的有关 TDH 的中文文献资料和一组 90例无症状受试者M R I检查资料进行分析比较。结果: 例 57 TD H 中,上中胸段 16例,占 28%,下胸段 41例,占 72%。文献资料 189例 TDH 中,上中胸段 55个,占 29.1%,下胸段 134个,占70.9%。文献资料中的 TD H 节段分布与本组临床资料中的 TDH 节段分布差异无显著性意义。一组 90例无症状志愿者 M RI检查在 57个节段有椎间盘突出,其中 T5 以上的上胸段15个, 以下的中下胸段 42个。 T5本组57例 TD H 患者在 80个节段有椎间盘突出,其中 T5 以上 个,T5 6以下 74个。经皮尔逊 χ检验 P <0.01,差异有显著性意义。即与无症 2状性 TD H 比较,有症状的 TDH 更常见于下胸段。结论:TD H 主要发生下胸段,这与下胸段活动度更大、椎间盘易于遭受急慢性机械性损伤的可能更大的情况是一致的,

AIM: To realize the segmental distributing characteristics of thoracic disc herniations(TDH) and the changeable characteristics of biomechanics, and probe into the possible factors inducing disease concerned with TDH. METHODS: ①The segmental contributing characteristics of 57 patients with TDH were analyzed. The time period of clinical materials was from January 1994 to December 2002. ②The clinical materials in the study group were compared with those of cases with TDH coming from recent 10 years Chinese medical periodical and those of a group of 90 subjects with asymptomatic intervertebral discs protrusions with MRI. RESULTS: Among 57 cases of TDH, 16 cases had TDH in the upper and middle thoracic segments(28%), and 41 in the lower thoracic segment (72%). Among 189 cases coming from medical periodical, 55 cases were in the upper and middle thoracic segments (29.1%), and 134 in the lower thoracic segment (70.9%). Of 57 herniated discs segments in 90 subjects with asymptomatic intervertebral disc protrusions, 15 were in the upper and middle thoracic segments (over T5); 42 were in the lower thoracic segment (below T5); Of 80 herniated discs in 57 cases, 6 were in the upper and middle thoracic segments (over T5); 74 segments in the lower thoracic segment (below T5); The difference between the two groups was significant (P< 0.01) with pearson chi-square test. Namely, compared with asymptomatic intervertebral discs protrusions, symptomatic intervertebral discs protrusions more frequently occur in the lower thoracic segment. CONCLUSION: TDH mainly occurs in the lower thoracic segment, which accords with more activity of thoracic segment and more possibility that intervertebral disc has incur acute and chronic mechanical injury. The biomechanical factors may play an important role in the pathogenesis of TDH.