老年人腰椎椎体变形与椎间盘退变的关系

THE RELATIONSHIP BETWEEN VERTEBRAL BODY DEFORMITY AND DISC DEGENERATION IN LUMBAR SPINE OF THE SENILE

目的：从生物力学和医学影像学角度研究老年性骨质疏松患者腰椎椎体变形与椎间盘退行性改变的关系。方法：采用三维有限元方法比较椎间盘正常及退变时腰椎的应力分布。影像学研究着重观察腰椎椎体变形与椎间盘高度及退变程度的关系。结果：生物力学研究发现，当椎间盘发生退变后椎体松质骨中央区的应力集中明显减轻，提示腰椎的载荷传递方式发生了明显变化。影像学研究结果表明，骨质疏松患者椎间盘高度低于正常者明显少于正常对照组（Ｐ＜００１），变形椎体下方的椎间盘退变程度较轻。结论：骨质疏松患者的椎体变形程度与其下方的椎间盘高度及退变程度具有十分明确的关系。当椎间盘高度减低或存在退行性改变时。

Objective:To investigate the relationship between vertebral deformity and disc degeneration in patients with senile osteoporosis using biomechanical and imaging methods.Methods:Three dimensional finite element models were used to compare the stress distribution of lumbar vertebrae with the disc normal or degenerated.The imaging data of the patients with osteoporotic spinal fractures were analysed to determine the relationship between vertebral deformities and disc height or degeneration.Results:In biomechanical study,significantly decreased stress concentration in the central part of the vertebral trabecullae was noted,indicating that with disc degeneration the way of load transmission in lumbar spine is altered.From imaging study,it was shown that the disc height of patients with osteoporosis was significantly decreased ( P <0 01) compared with the normal controls and the disc just below the deformed vertebral body is less degenerated.Conclusion:Vertebral deformity in osteoporotic patients is determined by height and degree of degeneration of the intervertebral disc just below this body.When the patients have their disc thinned or degenerated,the vertebral body just above the disc will be less susceptible to fracture.