歼击机飞行员无症状腰椎间盘突出的CT、X线检查分析

Computed tomography and radiology analysis of asymtomatic lumbar intervertebral disc protrusion in fighter pilots.

目的探讨歼击机飞行员经受的过荷作用对其腰椎和间盘组织可能产生的影响及其临床意义。方法同期采集一组歼击机飞行员和一组地勤人员的腰椎Ｘ线摄片及常规ＣＴ腰椎间隙扫描资料，进行腰椎间盘突（膨）出比率及与腰椎结构关系的比较分析。结果本组飞行员有明确的一节以上椎间盘突出者达２７％，若含膨出则高达４２％，远较地勤对照组（１８．５％）及以往所报告的普通正常人群（约１９％左右）为高。飞行员腰椎侧弯出现率较地勤人员也明显偏高，但两组对腰椎侧弯的代偿并无区别。研究还发现，椎间盘突出对腰椎结构有明显影响，飞行员组中有突出者的局部腰椎结构异常较无突出者更为显著，腰痛史亦更为明确。就突出椎间盘组织而言，本研究未发现其大小和位置与腰椎结构紊乱的相关关系。结论①过荷是加速腰椎退变因素之一，但因此而致的腰椎间盘突出一般可为飞行员代偿接受；②完善的腰椎功能状态很可能是结构代偿的基础；③虽然腰椎间盘突出椎管内占位一般可被代偿容纳，但仍不失为能引发椎管外腰椎结构紊乱的重要因素，需要引起康复保健医师的格外重视。

Objective To study the possible relation between the +G Z induced overloading pressure on spinal column and lumbar intervertebral disc protrusion and its clinical significance. Methods The lumbar vertebrae of 45 fighter pilots(overloading group) and 27 ground crew were examined with roentgenography and X ray computerized tomographic scanning for intervertebral disc protrusion and spine lateral list. Results The occurrence rate of obvious intervertebral disc protrusion in overloading group was 27% (42% if the bulging discs were included),significantly higher than that in control group (18.5%).But none of them claimed a history of serious low back trouble. The spine lateral list in overloading group is more evident than that in control group, and the list was well compesated at thoracic part of spine in both groups. The regional structure of spinal column was more obviously deformed in those pilots with protruded or bulged discs. The CT obseration and measurement did not show correlation between size and position of protruded disc tissure and the seriousness of spinal column disorder. Conclusion The results suggested that +G Z induced overloading was one of the cause leading degeneration of spine. The intervertebral disc protrusion usually could be compesated and asymptomatic, but it should be taken into consideretion in health measures for fighter pilots.